Provider Demographics
NPI:1255429270
Name:SCHUMACHER, ALICE R (LCSW)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:R
Last Name:SCHUMACHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 SAYBROOK ROAD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-343-6646
Mailing Address - Fax:860-343-5391
Practice Address - Street 1:770 SAYBROOK ROAD
Practice Address - Street 2:BUILDING B
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-343-6646
Practice Address - Fax:860-343-5391
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT0005391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
140000539CT01OtherBCBS
4264803OtherAETNA
108550OtherVALUE OPTIONS
079582OtherMHN
P2743627OtherOXFORD
P2743627OtherOXFORD