Allysa J Wachholder, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

074310 Issued in NY

Practice address

36 Clymer St
Port Jefferson Station, NY 11776-3913

Phone

(631) 828-6024

NPI assigned

Jul 6, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Senior Options Systems LCSW LLP

  • Clinical Social Worker
  • Stony Brook, NY
  • NPI 1811905292
  NPD (past)
• Senior Options Systems LLP

  • Clinical Social Worker
  • Stony Brook, NY
  • NPI 1467445098
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497787188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 CLYMER ST",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763913",
            "telephone_number": "631-828-6024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 CLYMER ST",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763913",
            "telephone_number": "631-828-6024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACHHOLDER",
        "first_name": "ALLYSA",
        "middle_name": "J",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "074310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mindy Vogt, MA, CF-SLP
• Lisa Volpe, RPH
• Kaitlyn Marie Von Werne
• Diane Voos, LPN
• Holly Ann Vulpis, CF-SLP
• Matthew Robert Wagner, MD
• Walgreen Co
• Walgreen Co
• Dawn M Walker
• Christine Marie Wall, RN

• Clinical Social Worker in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.