Provider Demographics
NPI:1760975858
Name:MCGILL, ALICIA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ELIZABETH
Last Name:MCGILL
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 1:4402 PEACH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1358
Mailing Address - Country:US
Mailing Address - Phone:814-920-4164
Mailing Address - Fax:814-920-4187
Practice Address - Street 1:4402 PEACH ST STE 6
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1358
Practice Address - Country:US
Practice Address - Phone:814-920-4164
Practice Address - Fax:814-920-4187
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0206171041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034990750003Medicaid