Healthcare Provider Details

I. General information

NPI: 1134439482
Provider Name (Legal Business Name): ARLENE AHL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 E GENESEE ST
SYRACUSE NY
13210-1912
US

IV. Provider business mailing address

408 HILLSBORO PKWY
SYRACUSE NY
13214-2029
US

V. Phone/Fax

Practice location:
  • Phone: 315-422-6828
  • Fax:
Mailing address:
  • Phone: 315-878-2603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR042376-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: