Provider Demographics
NPI:1538569538
Name:WU-CARDONA, ALICE P (LCSW)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:P
Last Name:WU-CARDONA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 BALBOA AVE # 553
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5504
Mailing Address - Country:US
Mailing Address - Phone:619-759-6166
Mailing Address - Fax:
Practice Address - Street 1:8715 BLUE LAKE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-3512
Practice Address - Country:US
Practice Address - Phone:619-759-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA934321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical