Individual
ALLYSA J WACHHOLDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
36 CLYMER ST, PORT JEFFERSON STATION, NY 11776-3913
(631) 828-6024
Mailing address
36 CLYMER ST, PORT JEFFERSON STATION, NY 11776-3913
(631) 828-6024
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
074310
NY
Other
Enumeration date
07/06/2006
Last updated
07/08/2007
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