Provider Demographics
NPI:1184077141
Name:VIEIRA, ALICIA NICOLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:NICOLE
Last Name:VIEIRA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:NICOLE
Other - Last Name:SHORR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9 COPPERBEECH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780
Mailing Address - Country:US
Mailing Address - Phone:845-746-6832
Mailing Address - Fax:718-334-5006
Practice Address - Street 1:7901 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-4000
Practice Address - Fax:718-334-5006
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR093952104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker