Provider Demographics
NPI:1912270034
Name:JANUARY, ALICIA M (PHD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:JANUARY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:JANUARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:SHRINERS HOSPITALS FOR CHILDREN
Mailing Address - Street 2:P.O. BOX 8500, LOCKBOX 7642
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:813-281-8115
Mailing Address - Fax:813-281-8656
Practice Address - Street 1:2211 N OAK PARK AVE
Practice Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-3351
Practice Address - Country:US
Practice Address - Phone:773-385-5585
Practice Address - Fax:773-385-5488
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009075103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical