Provider Demographics
NPI:1497033328
Name:KOHLHAGEN, ALICIA (LCSW-R)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:KOHLHAGEN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:M
Other - Last Name:COULTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2240 N FOREST RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1357
Mailing Address - Country:US
Mailing Address - Phone:716-344-0809
Mailing Address - Fax:716-847-2715
Practice Address - Street 1:2240 N FOREST RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-1357
Practice Address - Country:US
Practice Address - Phone:716-984-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY0837481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04353706Medicaid