Provider Demographics
NPI:1215078944
Name:ALICEA, SANDRA MARGARITA (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARGARITA
Last Name:ALICEA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 12TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3718
Mailing Address - Country:US
Mailing Address - Phone:772-299-7293
Mailing Address - Fax:772-299-6012
Practice Address - Street 1:1145 12TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3718
Practice Address - Country:US
Practice Address - Phone:772-299-7293
Practice Address - Fax:772-299-6012
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health