Provider Demographics
NPI:1487722039
Name:FUSSALVA, ARLEENE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ARLEENE
Middle Name:
Last Name:FUSSALVA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70654
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-0654
Mailing Address - Country:US
Mailing Address - Phone:646-239-6046
Mailing Address - Fax:
Practice Address - Street 1:BLDG 4066 602 STREET
Practice Address - Street 2:
Practice Address - City:FORT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703
Practice Address - Country:US
Practice Address - Phone:907-361-6059
Practice Address - Fax:907-360-6151
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR059175-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical