Provider Demographics
NPI:1609008317
Name:BRACCIA, ALICIA N (MA, CAS, ABSNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:N
Last Name:BRACCIA
Suffix:
Gender:F
Credentials:MA, CAS, ABSNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 S ALAFAYA TRL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8956
Mailing Address - Country:US
Mailing Address - Phone:407-382-5551
Mailing Address - Fax:
Practice Address - Street 1:1561 S ALAFAYA TRL
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8956
Practice Address - Country:US
Practice Address - Phone:407-382-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS710103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSS710OtherSTATE LICENSE