Provider Demographics
NPI:1144611401
Name:AREVALO, CECILIA MARISOL (LCSW)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:MARISOL
Last Name:AREVALO
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 1:556 MAUDE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7815
Mailing Address - Country:US
Mailing Address - Phone:516-462-5026
Mailing Address - Fax:
Practice Address - Street 1:175 FULTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550
Practice Address - Country:US
Practice Address - Phone:516-292-1034
Practice Address - Fax:516-292-0565
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092382-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker