Healthcare Provider Details

I. General information

NPI: 1760982615
Provider Name (Legal Business Name): MRS. ALICIA CELLINI PAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 SOUTHERLY PARC LN APT 301
ORANGE CITY FL
32763-8078
US

IV. Provider business mailing address

1212 SOUTHERLY PARC LN APT 301
ORANGE CITY FL
32763-8078
US

V. Phone/Fax

Practice location:
  • Phone: 386-564-5199
  • Fax:
Mailing address:
  • Phone: 386-564-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: