1881678019 NPI number — MS. ALISON SUSAN NYDICK HALLER LCSW

Table of content: (NPI 1780680033)

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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