Provider Demographics
NPI:1073187738
Name:ALICEA, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:ALICEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BOWDOIN ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4201
Mailing Address - Country:US
Mailing Address - Phone:617-742-4334
Mailing Address - Fax:617-544-2391
Practice Address - Street 1:41 BOWDOIN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4201
Practice Address - Country:US
Practice Address - Phone:617-742-4354
Practice Address - Fax:617-415-7799
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator