Provider Demographics
NPI:1417237439
Name:AHL, JULIET M (LCSW)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:M
Last Name:AHL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIET
Other - Middle Name:M
Other - Last Name:MENNELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:64 MOLE PL
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3627
Mailing Address - Country:US
Mailing Address - Phone:631-848-4345
Mailing Address - Fax:631-848-4345
Practice Address - Street 1:1 IRELAND PLACE, SUITE 1, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701
Practice Address - Country:US
Practice Address - Phone:631-525-7204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NY0834791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical