Provider Demographics
NPI:1578970448
Name:TEBBETT-MOCK, ALISON ANN (PHD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:ANN
Last Name:TEBBETT-MOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 DITMARS BLVD # 126
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1337
Mailing Address - Country:US
Mailing Address - Phone:917-409-6010
Mailing Address - Fax:
Practice Address - Street 1:4310 DITMARS BLVD # 126
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1337
Practice Address - Country:US
Practice Address - Phone:917-409-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-12
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020673103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist