Provider Demographics
NPI:1053005306
Name:VENTO, ALYSSA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:VENTO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 SMITHTOWN AVE APT 29
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-2149
Mailing Address - Country:US
Mailing Address - Phone:631-793-1601
Mailing Address - Fax:
Practice Address - Street 1:17 FORDHAM RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-5803
Practice Address - Country:US
Practice Address - Phone:631-321-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119321104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker