Provider Demographics
NPI:1831789767
Name:GOERGEN, ALISON (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:
Last Name:GOERGEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 W MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9397
Mailing Address - Country:US
Mailing Address - Phone:716-805-1555
Mailing Address - Fax:
Practice Address - Street 1:960 W MAPLE CT
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059-9397
Practice Address - Country:US
Practice Address - Phone:716-805-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025245103TC0700X
NYP108449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical