Individual
ALYSSA-RAY LEON BOUMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NYS CASAC
Contact information
Practice address
100 ROUTE 59 STE 117, AIRMONT, NY 10901-4927
(453) 699-7018
Mailing address
100 ROUTE 59 STE 117, AIRMONT, NY 10901-4927
(845) 369-9701
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
31918
NY
Other
Enumeration date
05/16/2019
Last updated
02/18/2020
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