Healthcare Provider Details

I. General information

NPI: 1760260921
Provider Name (Legal Business Name): ALEXIS HAMPILOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 17TH ST
SARASOTA FL
34235-1843
US

IV. Provider business mailing address

7560 BAY ISLAND DR S APT 347
SOUTH PASADENA FL
33707-4540
US

V. Phone/Fax

Practice location:
  • Phone: 941-371-8820
  • Fax:
Mailing address:
  • Phone: 727-410-7868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW20477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: