1659357903 NPI number — MS. ALICIA B. PAJARES LCSW

Table of content: (NPI 1649285719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659357903 NPI number — MS. ALICIA B. PAJARES LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAJARES
Provider First Name:
ALICIA
Provider Middle Name:
B.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659357903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1639 FORUM PL
Provider Second Line Business Mailing Address:
STE 7
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33401-2330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-712-8821
Provider Business Mailing Address Fax Number:
561-712-8070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15818 SW WARFIELD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANTOWN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34956-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-597-0411
Provider Business Practice Location Address Fax Number:
772-597-0412
Provider Enumeration Date:
12/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW5271 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 650789015 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 285593 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 764835900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 766992500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: SW5271 . This is a "FL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com