Healthcare Provider Details

I. General information

NPI: 1407947153
Provider Name (Legal Business Name): ALICIA S. HYATTE MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 S ORANGE BLOSSOM TRL STE 613
ORLANDO FL
32839
US

IV. Provider business mailing address

4530 S ORANGE BLOSSOM TRL STE 613
ORLANDO FL
32839-1704
US

V. Phone/Fax

Practice location:
  • Phone: 321-837-9745
  • Fax: 321-837-9745
Mailing address:
  • Phone: 321-837-9745
  • Fax: 321-837-9745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9245
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: