Healthcare Provider Details

I. General information

NPI: 1174479844
Provider Name (Legal Business Name): HEATHER VICTORIA AULT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CENTRAL AVE
ALBANY NY
12206-2937
US

IV. Provider business mailing address

PO BOX 12701
ALBANY NY
12212-2701
US

V. Phone/Fax

Practice location:
  • Phone: 518-882-8589
  • Fax:
Mailing address:
  • Phone: 518-882-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100418-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: