Provider Demographics
NPI:1871628958
Name:ALICEA, JANNETTE (MA)
Entity type:Individual
Prefix:MRS
First Name:JANNETTE
Middle Name:
Last Name:ALICEA
Suffix:
Gender:F
Credentials:MA
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 1113
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1113
Mailing Address - Country:US
Mailing Address - Phone:787-730-5076
Mailing Address - Fax:787-730-5076
Practice Address - Street 1:CARR. 167 KM. 14.6 BO. BUENA VISTA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-730-5076
Practice Address - Fax:787-730-5076
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1845103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1740Medicare UPIN
PR481592Medicare UPIN
PR9037Medicare UPIN
PR219172Medicare UPIN