Provider Demographics
NPI:1396735213
Name:ALIE, PAUL (LICSW)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:ALIE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1002
Mailing Address - Country:US
Mailing Address - Phone:617-965-0236
Mailing Address - Fax:
Practice Address - Street 1:1093 BEACON ST
Practice Address - Street 2:STE 104
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5623
Practice Address - Country:US
Practice Address - Phone:617-277-4238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P02034OtherBCBSMA PROVIDER NUMBER