Healthcare Provider Details

I. General information

NPI: 1679852511
Provider Name (Legal Business Name): ALICE HUANG LCSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 11TH ST SW
ALBUQUERQUE NM
87102-2988
US

IV. Provider business mailing address

PO BOX 4975
ALBUQUERQUE NM
87196-4975
US

V. Phone/Fax

Practice location:
  • Phone: 206-790-9963
  • Fax:
Mailing address:
  • Phone: 206-790-9963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-07494
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: