Healthcare Provider Details

I. General information

NPI: 1558050229
Provider Name (Legal Business Name): ALEXIS HOBSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19222 MESIC LANE
ESTERO FL
33928
US

IV. Provider business mailing address

19222 MESIC LANE
ESTERO FL
33928
US

V. Phone/Fax

Practice location:
  • Phone: 727-793-7306
  • Fax:
Mailing address:
  • Phone: 727-793-7306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: