Healthcare Provider Details

I. General information

NPI: 1427048669
Provider Name (Legal Business Name): ALLYAN WATSON RIVERA ORSINI LCSW RBCD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ALLYAN WATSON RIVERA LCSW RBCP

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FORDHAM RD
WEST BABYLON NY
11704-5803
US

IV. Provider business mailing address

45 INLET DR
LINDENHURST NY
11757-6804
US

V. Phone/Fax

Practice location:
  • Phone: 631-321-7011
  • Fax:
Mailing address:
  • Phone: 631-957-0788
  • Fax: 631-957-0788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberR0414081
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0414081
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: