Healthcare Provider Details

I. General information

NPI: 1851877666
Provider Name (Legal Business Name): SUSAN ELIZABETH ALEXE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2018
Last Update Date: 07/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 TOWER LN
AVON CT
06001-4237
US

IV. Provider business mailing address

4 WYNGATE DR
AVON CT
06001-4106
US

V. Phone/Fax

Practice location:
  • Phone: 877-577-3233
  • Fax:
Mailing address:
  • Phone: 941-586-3542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number010119
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: