Healthcare Provider Details

I. General information

NPI: 1649488495
Provider Name (Legal Business Name): JACQUELINE MARIE ALEXANDER MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 FARMS VILLAGE ROAD
WEST SIMSBURY CT
06092
US

IV. Provider business mailing address

PO BOX 404
WEST SIMSBURY CT
06092-0404
US

V. Phone/Fax

Practice location:
  • Phone: 860-693-4599
  • Fax: 860-693-4452
Mailing address:
  • Phone: 860-408-1595
  • Fax: 860-693-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001364
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: