Provider Demographics
NPI:1437608460
Name:BURNSIDE, ALISHA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:
Last Name:BURNSIDE
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 1:11808 LANCASHIRE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2636
Mailing Address - Country:US
Mailing Address - Phone:813-285-8804
Mailing Address - Fax:
Practice Address - Street 1:13919 CARROLLWOOD VILLAGE RUN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618
Practice Address - Country:US
Practice Address - Phone:813-285-8804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW137391041C0700X
FLSW 137391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW13739OtherLICENSE NUMBER