Provider Demographics
NPI:1972734309
Name:CAFFREY, ALICIA MERIE
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MERIE
Last Name:CAFFREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:LELIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-3525
Mailing Address - Country:US
Mailing Address - Phone:235-889-9978
Mailing Address - Fax:
Practice Address - Street 1:102 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-3525
Practice Address - Country:US
Practice Address - Phone:423-588-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5750103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical