Provider Demographics
NPI:1720813405
Name:MICKET, ALEJANDRINA (LCSW)
Entity type:Individual
Prefix:MS
First Name:ALEJANDRINA
Middle Name:
Last Name:MICKET
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 1:413 CONCHA DR
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-6503
Mailing Address - Country:US
Mailing Address - Phone:772-783-5300
Mailing Address - Fax:
Practice Address - Street 1:413 CONCHA DR
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-6503
Practice Address - Country:US
Practice Address - Phone:772-783-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1279981041C0700X
FLSW81151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical