Provider Demographics
NPI:1184632663
Name:KIM, ALICE J (LICSW)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:J
Last Name:KIM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4540
Mailing Address - Country:US
Mailing Address - Phone:781-338-7270
Mailing Address - Fax:781-396-5086
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE 112
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4540
Practice Address - Country:US
Practice Address - Phone:781-338-7270
Practice Address - Fax:781-396-5086
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1114121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical