Provider Demographics
NPI:1104193929
Name:BIVENS, ALISA R (LCSW)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:R
Last Name:BIVENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:B
Other - Last Name:LONGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1501 ALEXANDRIA PIKE STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2561
Mailing Address - Country:US
Mailing Address - Phone:207-400-7758
Mailing Address - Fax:
Practice Address - Street 1:1501 ALEXANDRIA PIKE STE 102
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-2561
Practice Address - Country:US
Practice Address - Phone:207-400-7758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1455581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical