Healthcare Provider Details

I. General information

NPI: 1316501380
Provider Name (Legal Business Name): ALICE WEIJIA HUANG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BROADWAY # 5381
ALBANY NY
12207-2922
US

IV. Provider business mailing address

64 GLEN RIDGE RD
NORWICH VT
05055-9406
US

V. Phone/Fax

Practice location:
  • Phone: 802-234-1341
  • Fax:
Mailing address:
  • Phone: 802-234-1341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number106319
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number094827
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: