Provider Demographics
NPI:1598907354
Name:LEDESMA, ALICIA ALCOCER (MA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ALCOCER
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 W OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3688
Mailing Address - Country:US
Mailing Address - Phone:602-707-2318
Mailing Address - Fax:
Practice Address - Street 1:1420 W OSBORN RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3688
Practice Address - Country:US
Practice Address - Phone:602-707-2318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3731873103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool