=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740087089
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALISA FEA LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2025
-----------------------------------------------------
Last Update Date | 02/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 S ROUTE 9W STE 209
-----------------------------------------------------
City | WEST HAVERSTRAW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10993-1053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-941-3810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 EAGLE RIDGE WAY
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-1025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-826-5449
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 126369-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------