Provider Demographics
NPI:1275920753
Name:COREY, ALICEA (MA ,MFT)
Entity Type:Individual
Prefix:MS
First Name:ALICEA
Middle Name:
Last Name:COREY
Suffix:
Gender:F
Credentials:MA ,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 NAUGATUCK AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-4059
Mailing Address - Country:US
Mailing Address - Phone:203-307-1123
Mailing Address - Fax:203-283-7714
Practice Address - Street 1:580 NAUGATUCK AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461
Practice Address - Country:US
Practice Address - Phone:203-307-1123
Practice Address - Fax:203-283-7714
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001852106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist