Healthcare Provider Details

I. General information

NPI: 1750712691
Provider Name (Legal Business Name): ALICIA JOEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA JOEL LCSW

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 ALDEN RD
PARAMUS NJ
07652-3734
US

IV. Provider business mailing address

57 ALDEN RD
PARAMUS NJ
07652-3734
US

V. Phone/Fax

Practice location:
  • Phone: 201-625-2816
  • Fax:
Mailing address:
  • Phone: 201-625-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05227600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: