Healthcare Provider Details

I. General information

NPI: 1932195260
Provider Name (Legal Business Name): ALEXANDRA ANN LONC LCSW, MAC, CGAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 NW 61ST AVE
PARKLAND FL
33067-4404
US

IV. Provider business mailing address

6201 NW 61ST AVE
PARKLAND FL
33067-4404
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 NumberSW7126
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: