Provider Demographics
NPI:1619157716
Name:MACGOWAN, ALICIA ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ANN
Last Name:MACGOWAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 FAIRHILL DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1310
Mailing Address - Country:US
Mailing Address - Phone:310-508-9531
Mailing Address - Fax:
Practice Address - Street 1:2138 FAIRHILL DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-1310
Practice Address - Country:US
Practice Address - Phone:310-508-9531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS213031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical