Provider Demographics
NPI:1497017214
Name:SOUTHWELL, ALICIA ALTMAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:ALTMAN
Last Name:SOUTHWELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LOWERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-2051
Mailing Address - Country:US
Mailing Address - Phone:781-899-8401
Mailing Address - Fax:
Practice Address - Street 1:4 LOWERFIELD RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-2051
Practice Address - Country:US
Practice Address - Phone:781-899-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical