Provider Demographics
NPI:1508643339
Name:BUKZIN, ARIEL LOUISE (LMSW)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:LOUISE
Last Name:BUKZIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 PRESIDENT RD
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-2619
Mailing Address - Country:US
Mailing Address - Phone:631-512-3480
Mailing Address - Fax:
Practice Address - Street 1:28 PRESIDENT RD
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-2619
Practice Address - Country:US
Practice Address - Phone:631-512-3480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121213104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker