Healthcare Provider Details

I. General information

NPI: 1356535710
Provider Name (Legal Business Name): ALEXANDRA A LONC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E HILLSBORO BLVD 201
DEERFIELD BEACH FL
33441-4235
US

IV. Provider business mailing address

1300 E HILLSBORO BLVD 201
DEERFIELD BEACH FL
33441-4235
US

V. Phone/Fax

Practice location:
  • Phone: 954-540-6335
  • Fax: 954-429-8338
Mailing address:
  • Phone: 954-540-6335
  • Fax: 954-429-8338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 7126
License Number StateFL

VIII. Authorized Official

Name: MS. ALEXANDRA ANN LONC
Title or Position: PSYCHOTHERAPIST
Credential: LCSW, CAP, CST, CFAE
Phone: 954-540-6335