Provider Demographics
NPI:1104639665
Name:ALICEA, JANNETTE
Entity type:Individual
Prefix:MRS
First Name:JANNETTE
Middle Name:
Last Name:ALICEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 PMB RR8 BOX 1995
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9676
Mailing Address - Country:US
Mailing Address - Phone:787-403-8874
Mailing Address - Fax:
Practice Address - Street 1:339 PMB RR8 BOX 1995
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9676
Practice Address - Country:US
Practice Address - Phone:787-403-8874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral