Provider Demographics
NPI:1578977161
Name:STITELER, ALICIA BOGGIO (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:BOGGIO
Last Name:STITELER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:SUE
Other - Last Name:BOGGIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:909-620-7769
Mailing Address - Fax:877-778-6944
Practice Address - Street 1:887 E. SECOND ST.
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2009
Practice Address - Country:US
Practice Address - Phone:909-620-7769
Practice Address - Fax:877-778-6944
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254521041C0700X
CALCS25452104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical