Provider Demographics
NPI:1033549795
Name:POPE, ALICE WILD (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:WILD
Last Name:POPE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8000 UTOPIA PKWY
Mailing Address - Street 2:PSYCHOLOGY, ST. JOHN'S UNIVERSITY, 409 MARILLAC HALL
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11439-9000
Mailing Address - Country:US
Mailing Address - Phone:718-990-1444
Mailing Address - Fax:
Practice Address - Street 1:15211 UNION TPKE
Practice Address - Street 2:CENTER FOR PSYCHOLOGICAL SERVICES
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3908
Practice Address - Country:US
Practice Address - Phone:718-990-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-17
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010611-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist