=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891042313
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAYNE ESTELLE RICHARDSON LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2012
-----------------------------------------------------
Last Update Date | 12/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 WALL ST # 954
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10005-4301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-933-5958
-----------------------------------------------------
Fax | 646-933-5959
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 442 5TH AVE # 1351
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10018-2794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-905-9466
-----------------------------------------------------
Fax | 917-900-1678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 086205
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------