Healthcare Provider Details

I. General information

NPI: 1508744111
Provider Name (Legal Business Name): DR. ALICIA STAATS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 E NEW ENGLAND AVE STE 225
WINTER PARK FL
32789-7000
US

IV. Provider business mailing address

157 E NEW ENGLAND AVE STE 225
WINTER PARK FL
32789-7000
US

V. Phone/Fax

Practice location:
  • Phone: 321-323-3167
  • Fax: 321-379-8282
Mailing address:
  • Phone: 321-323-3167
  • Fax: 321-379-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPPY406
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPPY406
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPPY406
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPPY406
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPPY406
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPPY406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: