Provider Demographics
NPI:1720598477
Name:ALICEA, ANGELINE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELINE
Middle Name:
Last Name:ALICEA
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 1:30 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3602
Mailing Address - Country:US
Mailing Address - Phone:617-254-3800
Mailing Address - Fax:
Practice Address - Street 1:30 WARREN ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3602
Practice Address - Country:US
Practice Address - Phone:617-254-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1134107113OtherMBHP
MAY10086OtherMEDICARE
MA71756OtherTUFTS
MA042622756OtherCCA
MA1134107113OtherFALLON
MA997303OtherNETWORK HEALTH
MA12529OtherHNE
MA1134107113OtherNHP
MA1134107113OtherBEACON
MA1134107113Medicaid