Provider Demographics
NPI:1255388567
Name:ALPERT, DEANNA (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:
Last Name:ALPERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53840 MAIN RD
Mailing Address - Street 2:PO BOX 955
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-4625
Mailing Address - Country:US
Mailing Address - Phone:631-734-2831
Mailing Address - Fax:631-734-5962
Practice Address - Street 1:53840 MAIN RD
Practice Address - Street 2:BOX 955
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-4625
Practice Address - Country:US
Practice Address - Phone:631-765-3802
Practice Address - Fax:631-734-5962
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR016163-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR016163-1OtherSTATE LICENSE #
NYN61751Medicare UPIN
NYN61751Medicare ID - Type UnspecifiedPROVIDER # FOR EMPIRE TOO
NYR016163-1OtherSTATE LICENSE #