MEDICARE: ALICE SUE BOUHADIR MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	SW1873	FL
2	1041C0700X	Clinical Social Worker	SWOOO1873	FL

General Provider Information

NPI Number	:	1336359207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE SUE BOUHADIR MSW, LCSW

Provider Business Mailing Address
First Line	:	PO BOX 542393
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33454-2393
Country	:	US
Telephone Number	:	561-827-3590
Fax Number	:

Provider Business Practice Location Address
First Line	:	7721 N MILITARY TRL STE 3-5
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-7429
Country	:	US
Telephone Number	:	954-731-5100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	05/01/2024

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