Provider Demographics
NPI:1992782379
Name:MATTESON, ALICIA ANNE (MA)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANNE
Last Name:MATTESON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:ANN
Other - Last Name:VALLENI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:62 E DARBY CIR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-6000
Mailing Address - Country:US
Mailing Address - Phone:302-698-1756
Mailing Address - Fax:
Practice Address - Street 1:300 TUSKEGEE BLVD
Practice Address - Street 2:
Practice Address - City:DOVER AFB
Practice Address - State:DE
Practice Address - Zip Code:19902-5300
Practice Address - Country:US
Practice Address - Phone:302-677-2674
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist