Healthcare Provider Details

I. General information

NPI: 1104493469
Provider Name (Legal Business Name): ALICIA EAD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 HARTFORD AVE
JOHNSTON RI
02919-3224
US

IV. Provider business mailing address

1 MARIA ST
LINCOLN RI
02865-1400
US

V. Phone/Fax

Practice location:
  • Phone: 401-556-1149
  • Fax:
Mailing address:
  • Phone: 401-556-1149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04312
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW02654
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: