1144629122 NPI number — ALEXANDRA GARFUNKEL CORRADO MSW, LICSW

Table of content: ALEXANDRA GARFUNKEL CORRADO MSW, LICSW (NPI 1144629122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144629122 NPI number — ALEXANDRA GARFUNKEL CORRADO MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORRADO
Provider First Name:
ALEXANDRA
Provider Middle Name:
GARFUNKEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CORRADO
Provider Other First Name:
SASHA
Provider Other Middle Name:
GARFUNKEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LICSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144629122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 CHELMSFORD ST STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHELMSFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01824-2305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-801-8493
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 CHELMSFORD ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELMSFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01824-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-801-8493
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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