Basic Information
| Provider Information | |||||||||
| NPI: | 1700436052 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALICEA | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | BELLE | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 VINCENT AVE APT 1A | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104651453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3477979688 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4123 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104576222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182993045 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2019 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 107145 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.