MEDICARE: NICHOLAS ALEXANDER

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	106S00000X	Behavior Technician
2	104100000X	Social Worker	6851115147	MI

General Provider Information

NPI Number	:	1558921213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS ALEXANDER

Provider Business Mailing Address
First Line	:	3875 YORKSHIRE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-2325
Country	:	US
Telephone Number	:	313-882-6352
Fax Number	:

Provider Business Practice Location Address
First Line	:	3875 YORKSHIRE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-2325
Country	:	US
Telephone Number	:	313-882-6352
Fax Number	:

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

Provider Enumeration Date	:	06/15/2019
Last Update Date	:	11/14/2023

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Directions to “ NICHOLAS ALEXANDER ” Practice Location

Language	Start Address	Practice Location

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