Provider Demographics
NPI:1962900464
Name:RAGER, ALECIA (MSW)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:RAGER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 LUCCA ST APT 201
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-5366
Mailing Address - Country:US
Mailing Address - Phone:239-410-6221
Mailing Address - Fax:
Practice Address - Street 1:390 PONDELLA RD STE 9
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4340
Practice Address - Country:US
Practice Address - Phone:239-652-0260
Practice Address - Fax:239-652-0146
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW98511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical