Provider Demographics
NPI:1356188247
Name:HARGROVE, ALICE (LPCA)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 EVERGREEN AVE APT 6A
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2723
Mailing Address - Country:US
Mailing Address - Phone:254-205-0857
Mailing Address - Fax:
Practice Address - Street 1:4 CORPORATE DR STE 490
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6263
Practice Address - Country:US
Practice Address - Phone:203-673-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7447101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health