Provider Demographics
NPI:1922564368
Name:POUGH, AREALUS (LICSW)
Entity Type:Individual
Prefix:MR
First Name:AREALUS
Middle Name:
Last Name:POUGH
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DUNNS HILL RD APT 4
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4157
Mailing Address - Country:US
Mailing Address - Phone:617-533-8133
Mailing Address - Fax:
Practice Address - Street 1:1 DUNNS HILL RD APT 4
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4157
Practice Address - Country:US
Practice Address - Phone:773-793-1793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1209541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical