Healthcare Provider Details

I. General information

NPI: 1962900464
Provider Name (Legal Business Name): ALECIA RAGER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 PONDELLA RD STE 9
NORTH FORT MYERS FL
33903-4340
US

IV. Provider business mailing address

12000 LUCCA ST APT 201
FORT MYERS FL
33966-5366
US

V. Phone/Fax

Practice location:
  • Phone: 239-652-0260
  • Fax: 239-652-0146
Mailing address:
  • Phone: 239-410-6221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW9851
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: