Provider Demographics
NPI:1790980431
Name:JUSTUS, ALICIA N (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:N
Last Name:JUSTUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5276
Mailing Address - Country:US
Mailing Address - Phone:401-851-2050
Mailing Address - Fax:401-851-2051
Practice Address - Street 1:82 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5276
Practice Address - Country:US
Practice Address - Phone:401-851-2050
Practice Address - Fax:401-851-2051
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00946103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical