MEDICARE: ALEXA TABB LCSW

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	34008095A	IN

General Provider Information

NPI Number	:	1235634288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA TABB LCSW

Provider Business Mailing Address
First Line	:	815 REGAL RD
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94708-1307
Country	:	US
Telephone Number	:	765-413-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2375 SHATTUCK AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-3298
Country	:	US
Telephone Number	:	765-413-1900
Fax Number	:

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

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	01/24/2025

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