Provider Demographics
NPI:1174871388
Name:HANSOME, ALICIA MONIQUE (LMSW)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:MONIQUE
Last Name:HANSOME
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E 191ST ST APT 1E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-4580
Mailing Address - Country:US
Mailing Address - Phone:347-325-8644
Mailing Address - Fax:
Practice Address - Street 1:50 E 191ST ST APT 1E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-4580
Practice Address - Country:US
Practice Address - Phone:347-325-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077849104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker