Healthcare Provider Details

I. General information

NPI: 1568045177
Provider Name (Legal Business Name): ALYSSA NICOLE CABRERA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 APPEL DR E
SHIRLEY NY
11967-3635
US

IV. Provider business mailing address

48 APPEL DR E
SHIRLEY NY
11967-3635
US

V. Phone/Fax

Practice location:
  • Phone: 631-871-3237
  • Fax:
Mailing address:
  • Phone: 631-871-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number089308-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089308-01
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: