Provider Demographics
NPI:1992067136
Name:USELMANN, ALICIA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANN
Last Name:USELMANN
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 1:3300 LOVELAND BLVD UNIT 2904
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-6722
Mailing Address - Country:US
Mailing Address - Phone:941-769-1052
Mailing Address - Fax:
Practice Address - Street 1:3300 LOVELAND BLVD UNIT 2904
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-6722
Practice Address - Country:US
Practice Address - Phone:941-769-1052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW100681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical