Provider Demographics
NPI:1083986137
Name:FAY, ALICIA ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:ANNE
Last Name:FAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 MISSION AVE
Mailing Address - Street 2:SUITE 238
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1326
Mailing Address - Country:US
Mailing Address - Phone:760-754-5500
Mailing Address - Fax:760-757-0792
Practice Address - Street 1:103 RANCHO DEL ORO DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-7345
Practice Address - Country:US
Practice Address - Phone:760-453-2300
Practice Address - Fax:760-453-2303
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 218571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical