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General NPI Number Information
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NPI Number | 1710176268
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Entity Type | Individual
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Provider Name | ALICIA MEMENZA LICSW
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Gender | Female
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 22 HIGH ST
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City | BROOKLINE
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State | MA
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Zip | 02445-7713
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Country | US
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Telephone | 857-364-0255
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Fax |
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Provider Business Mailing Address
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Address Line | 223 ESSEX ST APT 43
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City | MELROSE
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State | MA
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Zip | 02176-3183
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Country | US
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Telephone | 617-669-9658
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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 | 111579
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License Number State | MA
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