Healthcare Provider Details

I. General information

NPI: 1750653077
Provider Name (Legal Business Name): ROSANGELA ALICEA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 BROADWAY
NEWBURGH NY
12550-6204
US

IV. Provider business mailing address

49 SCOTCHTOWN PL
MIDDLETOWN NY
10941-1411
US

V. Phone/Fax

Practice location:
  • Phone: 845-568-5260
  • Fax: 845-568-5213
Mailing address:
  • Phone: 466-244-3811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number091620
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number086499
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: