Provider Demographics
NPI:1083115307
Name:AECKERLE, SCARLETT (LMSW)
Entity Type:Individual
Prefix:
First Name:SCARLETT
Middle Name:
Last Name:AECKERLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SCARLETT
Other - Middle Name:
Other - Last Name:BENJAMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:6668 4TH SECTION RD
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2448
Mailing Address - Country:US
Mailing Address - Phone:585-637-2670
Mailing Address - Fax:
Practice Address - Street 1:6668 4TH SECTION RD
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-2448
Practice Address - Country:US
Practice Address - Phone:585-637-2670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042538104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker