Healthcare Provider Details

I. General information

NPI: 1891306411
Provider Name (Legal Business Name): ALEXANDER ABATE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 W LAKEVIEW AVE
LAKE MARY FL
32746-2908
US

IV. Provider business mailing address

23604 VALDERAMA LN
SORRENTO FL
32776-6931
US

V. Phone/Fax

Practice location:
  • Phone: 407-330-5060
  • Fax:
Mailing address:
  • Phone: 314-223-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: