Provider Demographics
NPI:1902261647
Name:D'ALO, ALLEGRA GRACE (LMSW)
Entity Type:Individual
Prefix:
First Name:ALLEGRA
Middle Name:GRACE
Last Name:D'ALO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:ALLEGRA
Other - Middle Name:GRACE
Other - Last Name:ROOHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:90 DRIVING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:90 DRIVING PARK AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563
Practice Address - Country:US
Practice Address - Phone:516-851-0738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090785-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker