Provider Demographics
NPI:1033451026
Name:LOVELL, ALICE (PHD, RN)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:LOVELL
Suffix:
Gender:F
Credentials:PHD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 KACHUBA CT
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-3666
Mailing Address - Country:US
Mailing Address - Phone:407-951-3150
Mailing Address - Fax:
Practice Address - Street 1:305 KACHUBA CT
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3666
Practice Address - Country:US
Practice Address - Phone:407-951-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6619103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical