Healthcare Provider Details

I. General information

NPI: 1265803951
Provider Name (Legal Business Name): DAVID JAMES ARAKELIAN LICSW, LCSW, CSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC 11050 MOUNT BELVEDERE BLVD
FORT DRUM NY
13602-5438
US

IV. Provider business mailing address

USA MEDDAC 11050 MOUNT BELVEDERE BLVD
FORT DRUM NY
13602-5438
US

V. Phone/Fax

Practice location:
  • Phone: 315-772-2029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60640057
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number63793
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009189
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710102959
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: