Provider Demographics
NPI:1053505040
Name:ANDERSON, ALICIA JOAN
Entity Type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:JOAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21437 LEE DR.
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95033
Mailing Address - Country:US
Mailing Address - Phone:925-640-8985
Mailing Address - Fax:
Practice Address - Street 1:555 MOWRY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4110
Practice Address - Country:US
Practice Address - Phone:510-742-3904
Practice Address - Fax:510-742-3912
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-01
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor