Provider Demographics
NPI:1073030474
Name:DEHAVEN, ALISON ARTHUR (LCSW)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:ARTHUR
Last Name:DEHAVEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SPRINGFIELD AVE APT 18
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2157
Mailing Address - Country:US
Mailing Address - Phone:212-781-7822
Mailing Address - Fax:
Practice Address - Street 1:24 SPRINGFIELD AVE APT 18
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2157
Practice Address - Country:US
Practice Address - Phone:212-781-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0716881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical