Provider Demographics
NPI:1801231758
Name:FLEMING, ALICIA RENAE (CABA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:RENAE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:CABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20820 QUINELLA ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32833-4985
Mailing Address - Country:US
Mailing Address - Phone:321-213-4220
Mailing Address - Fax:
Practice Address - Street 1:20820 QUINELLA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32833-4985
Practice Address - Country:US
Practice Address - Phone:321-213-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-04-1284103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst