Provider Demographics
NPI:1356062152
Name:VAILLANCOURT, ALICIA
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:VAILLANCOURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02724-1624
Mailing Address - Country:US
Mailing Address - Phone:508-415-0531
Mailing Address - Fax:
Practice Address - Street 1:379 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02724-1624
Practice Address - Country:US
Practice Address - Phone:508-415-0531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health