Healthcare Provider Details

I. General information

NPI: 1881908606
Provider Name (Legal Business Name): ALICIA TEIXEIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 N MAIN ST
FALL RIVER MA
02720-2917
US

IV. Provider business mailing address

21 NYE AVE
ACUSHNET MA
02743-2749
US

V. Phone/Fax

Practice location:
  • Phone: 508-324-4202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: