Provider Demographics
NPI:1902104409
Name:CHILCOTE, ALICE H (RN, MSW, LSW)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:H
Last Name:CHILCOTE
Suffix:
Gender:F
Credentials:RN, MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E MAIN ST
Mailing Address - Street 2:PO BOX 337
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-1711
Mailing Address - Country:US
Mailing Address - Phone:610-965-2000
Mailing Address - Fax:
Practice Address - Street 1:304 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-1711
Practice Address - Country:US
Practice Address - Phone:610-965-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW00174E103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist