Provider Demographics
NPI:1811424955
Name:AXELROD-HAHN, ARIEL E (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:ARIEL
Middle Name:E
Last Name:AXELROD-HAHN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:MS
Other - First Name:ARIEL
Other - Middle Name:
Other - Last Name:AXELROD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:1234 BROADWAY STE 6
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1703
Mailing Address - Country:US
Mailing Address - Phone:857-246-8383
Mailing Address - Fax:
Practice Address - Street 1:1234 BROADWAY STE 6
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1703
Practice Address - Country:US
Practice Address - Phone:857-246-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11882101YM0800X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker