Provider Demographics
NPI:1528219946
Name:VONHAHN, DETLEF (CASAC)
Entity Type:Individual
Prefix:MR
First Name:DETLEF
Middle Name:
Last Name:VONHAHN
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3317
Mailing Address - Country:US
Mailing Address - Phone:914-683-8050
Mailing Address - Fax:914-683-8054
Practice Address - Street 1:7 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3317
Practice Address - Country:US
Practice Address - Phone:914-683-8050
Practice Address - Fax:914-683-8054
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01037705Medicaid