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General NPI Number Information
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NPI Number | 1588286538
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Entity Type | Individual
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Provider Name | ALICE TERESA ZIC MPH, LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 752 MIDDLETOWN RD UNIT A
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City | COLCHESTER
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State | CT
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Zip | 06415-2307
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Country | US
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Telephone | 203-800-9011
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Fax |
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Provider Business Mailing Address
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Address Line | 3611 CHAIN BRIDGE RD STE C
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City | FAIRFAX
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State | VA
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Zip | 22030-3246
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Country | US
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Telephone | 703-634-9733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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