Provider Demographics
NPI:1942575261
Name:ALTMAN-KUTLER, MARLENE A (LCSW, CASAC, ICADC)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:A
Last Name:ALTMAN-KUTLER
Suffix:
Gender:F
Credentials:LCSW, CASAC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MALVERNE AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1412
Mailing Address - Country:US
Mailing Address - Phone:516-476-3179
Mailing Address - Fax:
Practice Address - Street 1:37 MALVERNE AVE
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1412
Practice Address - Country:US
Practice Address - Phone:516-476-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5955101YA0400X
NYRO598051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)