Provider Demographics
NPI:1366965212
Name:KANTOR, ALICE WILLA (LICSW)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:WILLA
Last Name:KANTOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 MERRIMACK ST FL 5
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6112
Mailing Address - Country:US
Mailing Address - Phone:617-833-7143
Mailing Address - Fax:
Practice Address - Street 1:191 MERRIMACK ST FL 5
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6112
Practice Address - Country:US
Practice Address - Phone:617-833-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1144861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical