Healthcare Provider Details

I. General information

NPI: 1457085292
Provider Name (Legal Business Name): ALYSHA TAYLOR MEMMELAAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 ROUTE 44 STE F
SALT POINT NY
12578-8040
US

IV. Provider business mailing address

2510 ROUTE 44 STE F
SALT POINT NY
12578-8040
US

V. Phone/Fax

Practice location:
  • Phone: 845-768-3178
  • Fax: 845-707-4398
Mailing address:
  • Phone: 845-768-3178
  • Fax: 845-707-4398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101965
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: