Provider Demographics
NPI:1063239283
Name:TANZINI, ALIECE (CASAC II, SAP, CLC)
Entity type:Individual
Prefix:
First Name:ALIECE
Middle Name:
Last Name:TANZINI
Suffix:
Gender:F
Credentials:CASAC II, SAP, CLC
Other - Prefix:
Other - First Name:ALIECE
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 RUTH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:13795-1215
Mailing Address - Country:US
Mailing Address - Phone:607-743-1174
Mailing Address - Fax:
Practice Address - Street 1:16 RUTH ST
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:NY
Practice Address - Zip Code:13795-1215
Practice Address - Country:US
Practice Address - Phone:607-743-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAOYTWBCAVO171400000X
NYSSSAPA0321-X68101YA0400X
NY32375101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171400000XOther Service ProvidersHealth & Wellness Coach