MEDICARE: ANGEL ALEXION MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW23464	FL
2	1041C0700X	Clinical Social Worker		FL

General Provider Information

NPI Number	:	1063050391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL ALEXION MSW

Provider Business Mailing Address
First Line	:	9354 KETAY CIR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1519
Country	:	US
Telephone Number	:	561-305-8437
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 SE OCEAN BLVD STE 340
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-3502
Country	:	US
Telephone Number	:	772-220-3439
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	11/04/2024

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