Provider Demographics
NPI:1427581180
Name:AMICO, ALEXANDER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:AMICO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 EAST ST
Mailing Address - Street 2:APT 254 E
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5406
Mailing Address - Country:US
Mailing Address - Phone:508-847-0316
Mailing Address - Fax:
Practice Address - Street 1:171 EAST ST
Practice Address - Street 2:APT 254 E
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5406
Practice Address - Country:US
Practice Address - Phone:508-847-0316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-09
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2222841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical