Provider Demographics
NPI:1891283164
Name:ROUNTREE, ALICIA (LICSW)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:ROUNTREE
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 1:245 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-1494
Mailing Address - Country:US
Mailing Address - Phone:781-767-4600
Mailing Address - Fax:781-767-7273
Practice Address - Street 1:245 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:MA
Practice Address - Zip Code:02343-1494
Practice Address - Country:US
Practice Address - Phone:781-767-4600
Practice Address - Fax:781-767-7273
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119661101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool