1043351075 NPI number — MS. ALICE MCCREERY L.C.S.W.

Table of content: MS. ALICE MCCREERY L.C.S.W. (NPI 1043351075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043351075 NPI number — MS. ALICE MCCREERY L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCREERY
Provider First Name:
ALICE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCREERY
Provider Other First Name:
ALI
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.C.S.W.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1043351075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3013 LONE JACK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024-7008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-442-1489
Provider Business Mailing Address Fax Number:
760-753-0687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3435 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-442-1489
Provider Business Practice Location Address Fax Number:
760-753-0687
Provider Enumeration Date:
02/11/2007

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: 101YM0800X , with the licence number:  LCS17285 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CSW172850 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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