MEDICARE: ALICIA S. HYATTE 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	174H00000X	Health Educator
2	1041C0700X	Clinical Social Worker	SW9245	FL

General Provider Information

NPI Number	:	1407947153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA S. HYATTE MSW, LCSW

Provider Business Mailing Address
First Line	:	4530 S ORANGE BLOSSOM TRL STE 613
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-1704
Country	:	US
Telephone Number	:	321-837-9745
Fax Number	:	321-837-9745

Provider Business Practice Location Address
First Line	:	4530 S ORANGE BLOSSOM TRL STE 613
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839
Country	:	US
Telephone Number	:	321-837-9745
Fax Number	:	321-837-9745

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	09/25/2019

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