Provider Demographics
NPI:1710430178
Name:SMALL, ARLENE (MSLADCI)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:MSLADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 HANCOCK ST STE 301
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5250
Mailing Address - Country:US
Mailing Address - Phone:617-328-0639
Mailing Address - Fax:617-328-2049
Practice Address - Street 1:1419 HANCOCK ST STE 301
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5250
Practice Address - Country:US
Practice Address - Phone:617-328-0639
Practice Address - Fax:617-328-2049
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13822101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)