Physician Compare National (NPI:1962737759)

HEALTHCARE PROVIDER: ALICIA DAWN COCKRUM PSYD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1962737759
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8628110624
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20121029000081
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	COCKRUM
	Individual professional last name
Provider First Name	ALICIA
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2008
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1024 SONOMA GLEN CIR
	Group Practice or individual's line 1 address
City	GLEN ELLEN
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	954429430
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7078162400
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y