Provider Demographics
NPI:1023421534
Name:TAVARES, ALICIA RAE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:RAE
Last Name:TAVARES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 ELMWOOD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-3669
Mailing Address - Country:US
Mailing Address - Phone:401-787-1265
Mailing Address - Fax:
Practice Address - Street 1:1093 ELMWOOD AVE APT 2
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-3669
Practice Address - Country:US
Practice Address - Phone:401-787-1265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00856101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health