Healthcare Provider Details

I. General information

NPI: 1184972861
Provider Name (Legal Business Name): ALDEN COUNSELING & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 BROADWAY ST
ALDEN NY
14004-9454
US

IV. Provider business mailing address

11901 BROADWAY ST
ALDEN NY
14004-9454
US

V. Phone/Fax

Practice location:
  • Phone: 716-937-3300
  • Fax: 716-937-3304
Mailing address:
  • Phone: 716-937-3300
  • Fax: 716-937-3304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076464
License Number StateNY

VIII. Authorized Official

Name: MS. SARAH ELIZABETH FITZGERALD
Title or Position: LICENSED CLINICL SOCIAL WORKER
Credential: LCSWR
Phone: 716-937-3300