Healthcare Provider Details

I. General information

NPI: 1063338515
Provider Name (Legal Business Name): MRS. ALEXANDRIA MONIQUE GIBBONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 PROSPECT AVE STE 103
HARTFORD CT
06105-4238
US

IV. Provider business mailing address

682 PROSPECT AVE STE 103
HARTFORD CT
06105-4238
US

V. Phone/Fax

Practice location:
  • Phone: 860-663-8131
  • Fax: 888-918-2702
Mailing address:
  • Phone: 860-663-8131
  • Fax: 888-918-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7242
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: