Healthcare Provider Details

I. General information

NPI: 1568139921
Provider Name (Legal Business Name): ALEXANDRA PAPPAS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD STE 231
NEWARK DE
19713-2074
US

IV. Provider business mailing address

4745 OGLETOWN STANTON RD STE 231
NEWARK DE
19713-2074
US

V. Phone/Fax

Practice location:
  • Phone: 302-320-2100
  • Fax:
Mailing address:
  • Phone: 302-320-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6819
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberB1-0011335
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: