MEDICARE: MISS ALYXANDRA NICOLE SHOBEN LSW

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	104100000X	Social Worker	SW137711	PA

General Provider Information

NPI Number	:	1669043519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ALYXANDRA NICOLE SHOBEN LSW

Provider Business Mailing Address
First Line	:	2024 COUNTRY CLUB DR
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15135-3002
Country	:	US
Telephone Number	:	412-706-0447
Fax Number	:

Provider Business Practice Location Address
First Line	:	523 RAVINE ST
Second Line	:
City	:	DRAVOSBURG
State	:	PA
Zip	:	15034-1012
Country	:	US
Telephone Number	:	412-896-5140
Fax Number	:

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

Provider Enumeration Date	:	07/01/2021
Last Update Date	:	07/01/2021

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