Provider Demographics
NPI:1124331368
Name:ANDRIA, ALICIA JEAN (LAC)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:JEAN
Last Name:ANDRIA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HORSEBLOCK RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1240
Mailing Address - Country:US
Mailing Address - Phone:631-478-7952
Mailing Address - Fax:
Practice Address - Street 1:700 HORSEBLOCK RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738
Practice Address - Country:US
Practice Address - Phone:631-732-1386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025687225700000X
NY4227171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist