Provider Demographics
NPI:1962932673
Name:AHRENS, PAULINE M (LMSW)
Entity type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:M
Last Name:AHRENS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:PAULINE
Other - Middle Name:M
Other - Last Name:FASANELLA-AHRENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:148 HEREFORD ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1632
Mailing Address - Country:US
Mailing Address - Phone:718-984-7752
Mailing Address - Fax:
Practice Address - Street 1:1082 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3622
Practice Address - Country:US
Practice Address - Phone:917-543-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050914104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker