Healthcare Provider Details

I. General information

NPI: 1326465386
Provider Name (Legal Business Name): ARLENE DETCHKOV LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 BRONX BLVD
BRONX NY
10470-1407
US

IV. Provider business mailing address

4401 BRONX BLVD FL 3
BRONX NY
10470-1407
US

V. Phone/Fax

Practice location:
  • Phone: 718-304-7086
  • Fax:
Mailing address:
  • Phone: 718-304-7086
  • Fax: 718-304-7065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05807200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: