1881678019 NPI number — MS. ALISON SUSAN NYDICK HALLER LCSW

Table of content: MS. ALISON SUSAN NYDICK HALLER LCSW (NPI 1881678019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881678019 NPI number — MS. ALISON SUSAN NYDICK HALLER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NYDICK HALLER
Provider First Name:
ALISON
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NYDICK
Provider Other First Name:
ALISON
Provider Other Middle Name:
SUSAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881678019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 E PEMBROKE CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAPPINGERS FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12590-5644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-765-2269
Provider Business Mailing Address Fax Number:
845-765-2268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1068 MAIN ST
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
FISHKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12524-3659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-765-2269
Provider Business Practice Location Address Fax Number:
845-765-2268
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R0378181 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P803653 . This is a "OXFORD" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 01961724 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251339219 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 100367H . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 121447 . This is a "MBH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1433866737 . This is a "CARE PLUS HEALTH PLAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 340435 . This is a "MHN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: N27361 . This is a "MBCC PRUDENTIAL" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 095408000 . This is a "MBH IBR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7483043 . This is a "MBH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 996118 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N7B32 . This is a "EBCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N458A1 . This is a "EBCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P11101072 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2105998 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0005397562 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1031400 . This is a "BEACON HEALTH STRATEGIES" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 135395 . This is a "AFFINITY HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 274646000 . This is a "MBH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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