Provider Demographics
NPI:1336359207
Name:BOUHADIR, ALICE SUE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:SUE
Last Name:BOUHADIR
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 542393
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33454-2393
Mailing Address - Country:US
Mailing Address - Phone:561-827-3590
Mailing Address - Fax:
Practice Address - Street 1:7721 N MILITARY TRL STE 3-5
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7429
Practice Address - Country:US
Practice Address - Phone:954-731-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW1873101YM0800X
FLSWOOO18731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3709Medicare ID - Type UnspecifiedPROVIDER NUMBER