Provider Demographics
NPI:1457672040
Name:GARGIULO, ALICIA LEE (MFTI)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:LEE
Last Name:GARGIULO
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:MRS
Other - First Name:ALICIA
Other - Middle Name:LEE
Other - Last Name:BLAZEWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 GIBSON DR APT 727
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5403
Mailing Address - Country:US
Mailing Address - Phone:559-240-3419
Mailing Address - Fax:
Practice Address - Street 1:7806 UPLANDS WAY STE A
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7567
Practice Address - Country:US
Practice Address - Phone:916-967-6253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62386106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist