Provider Demographics
NPI:1669760880
Name:SICERON-REYNA, ALFIDA E
Entity type:Individual
Prefix:
First Name:ALFIDA
Middle Name:E
Last Name:SICERON-REYNA
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 1:585 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1906
Mailing Address - Country:US
Mailing Address - Phone:508-831-0045
Mailing Address - Fax:508-753-5051
Practice Address - Street 1:484 MAIN ST
Practice Address - Street 2:SUITE 450
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1893
Practice Address - Country:US
Practice Address - Phone:508-752-2590
Practice Address - Fax:508-753-5051
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1306461Medicaid
MA1308785Medicaid
MA2220002001OtherBLUE CROSS
MAM18684OtherBLUE CROSS BLUE SHEILD
MA1308785Medicaid