Provider Demographics
NPI:1245038330
Name:MCNAMARA, ALICIA (LSW, LAC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:
Credentials:LSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 20 RD
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-9048
Mailing Address - Country:US
Mailing Address - Phone:970-283-7828
Mailing Address - Fax:
Practice Address - Street 1:1199 20 RD
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-9048
Practice Address - Country:US
Practice Address - Phone:970-283-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002671101YA0400X
COLSW.0009926058104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker