MEDICARE: DR. KIMBERLY CARRION ALICEA PSYD

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	103TC0700X	Clinical Psychologist	P10207	NY

General Provider Information

NPI Number	:	1720578719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY CARRION ALICEA PSYD

Provider Business Mailing Address
First Line	:	VILLA NEVAREZ 1135 CALLE 5 STE 1
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00927-5166
Country	:	US
Telephone Number	:	939-489-6744
Fax Number	:

Provider Business Practice Location Address
First Line	:	8461 LAKE WORTH RD BLDG 1
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2474
Country	:	US
Telephone Number	:	772-486-4417
Fax Number	:

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

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	12/09/2025

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