Healthcare Provider Details

I. General information

NPI: 1972709574
Provider Name (Legal Business Name): ALICE FICHANDLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 KENYON ST
SAN DIEGO CA
92110-5001
US

IV. Provider business mailing address

3420 KENYON ST.
SAN DIEGO CA
92110
US

V. Phone/Fax

Practice location:
  • Phone: 619-221-6550
  • Fax: 619-221-6556
Mailing address:
  • Phone: 619-226-6083
  • Fax: 619-221-6556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS11563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: