Provider Demographics
NPI:1114743150
Name:ALCIDE, ANDRENA
Entity type:Individual
Prefix:
First Name:ANDRENA
Middle Name:
Last Name:ALCIDE
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 1:3521 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4847
Mailing Address - Country:US
Mailing Address - Phone:319-654-7724
Mailing Address - Fax:
Practice Address - Street 1:3521 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33309-4847
Practice Address - Country:US
Practice Address - Phone:319-654-7724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician