Provider Demographics
NPI:1255674529
Name:ALDENDORFF, HOWARD (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:
Last Name:ALDENDORFF
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 FAYETTE ST # 2
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5262
Mailing Address - Country:US
Mailing Address - Phone:607-277-7182
Mailing Address - Fax:
Practice Address - Street 1:127 FAYETTE ST # 2
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5262
Practice Address - Country:US
Practice Address - Phone:607-277-7182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR043737-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical