MEDICARE: MS. CARMEN LUZ ALICEA-LAFOSSE MSW, MS

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	103T00000X	Psychologist
2	104100000X	Social Worker	5796	PR

General Provider Information

NPI Number	:	1619184819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARMEN LUZ ALICEA-LAFOSSE MSW, MS

Provider Business Mailing Address
First Line	:	RR 3 BOX 53020
Second Line	:
City	:	TOA ALTA
State	:	PR
Zip	:	00953-9803
Country	:	US
Telephone Number	:	787-473-6692
Fax Number	:	787-765-9035

Provider Business Practice Location Address
First Line	:	RR 3 BOX 53020
Second Line	:
City	:	TOA ALTA
State	:	PR
Zip	:	00953-9803
Country	:	US
Telephone Number	:	787-473-6692
Fax Number	:	787-765-9035

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	01/23/2008

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Directions to “ MS. CARMEN LUZ ALICEA-LAFOSSE MSW, MS” Practice Location

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