MEDICARE: ALECIA RAGER LCSW LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1982289120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALECIA RAGER LCSW LLC

Provider Business Mailing Address
First Line	:	17301 BROADWAY STREET
Second Line	:	#1004
City	:	ALVA
State	:	FL
Zip	:	33920
Country	:	US
Telephone Number	:	239-401-6221
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 COLONIAL BLVD STE 225
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1026
Country	:	US
Telephone Number	:	239-410-6221
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALECIA RAGER
Credential	:	LCSW
Telephone Number	:	239-410-6221

Provider Enumeration Date	:	03/09/2021
Last Update Date	:	03/09/2021

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