Provider Demographics
NPI:1538590880
Name:AGECHA, ALICE
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:AGECHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RUTGERS BEHAVIORAL HEALTH CARE
Mailing Address - Street 2:183 SOUTH ORANGE AVENUE
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103
Mailing Address - Country:US
Mailing Address - Phone:973-972-5430
Mailing Address - Fax:973-972-7173
Practice Address - Street 1:RUTGERS BEHAVIORAL HEALTH CARE
Practice Address - Street 2:183 SOUTH ORANGE AVENUE
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-5430
Practice Address - Fax:973-972-7173
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00474300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health