Provider Demographics
NPI:1467711978
Name:MOONAN, ALICIA L (LMHC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:L
Last Name:MOONAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:L
Other - Last Name:KOWALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:92 MEADOWLAWN RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-3609
Mailing Address - Country:US
Mailing Address - Phone:716-574-1581
Mailing Address - Fax:
Practice Address - Street 1:1010 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1102
Practice Address - Country:US
Practice Address - Phone:716-859-4803
Practice Address - Fax:716-859-4859
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004800-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health