Provider Demographics
NPI:1043351075
Name:MCCREERY, ALICE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:MCCREERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:MCCREERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3013 LONE JACK RD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-7008
Mailing Address - Country:US
Mailing Address - Phone:858-442-1489
Mailing Address - Fax:760-753-0687
Practice Address - Street 1:3435 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3902
Practice Address - Country:US
Practice Address - Phone:858-442-1489
Practice Address - Fax:760-753-0687
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS17285101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW172850Medicaid
CAR93007Medicare UPIN
CACSW172850Medicaid