Provider Demographics
NPI:1063988376
Name:RAMOS, ARIEL ORLANDO (CASAC 2)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:ORLANDO
Last Name:RAMOS
Suffix:
Gender:M
Credentials:CASAC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 AVENUE D APT 14E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7037
Mailing Address - Country:US
Mailing Address - Phone:718-316-0621
Mailing Address - Fax:
Practice Address - Street 1:2976 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2822
Practice Address - Country:US
Practice Address - Phone:347-510-3622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132645436101YA0400X
101YA0400X
NY29667101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1063988376Medicaid