Provider Demographics
NPI:1134982556
Name:PROKOPIAK, ALYCE LOVE (LAC)
Entity type:Individual
Prefix:
First Name:ALYCE
Middle Name:LOVE
Last Name:PROKOPIAK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MONROE ST APT 6
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-1731
Mailing Address - Country:US
Mailing Address - Phone:917-804-1799
Mailing Address - Fax:
Practice Address - Street 1:506 3RD ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-1970
Practice Address - Country:US
Practice Address - Phone:201-885-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00494100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health