Healthcare Provider Details

I. General information

NPI: 1447402177
Provider Name (Legal Business Name): DOLORES LEXANDRA PH.D., MSW,C.A.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 A1A S STE 11 PMB 136
ST AUGUSTINE FL
32080-8052
US

IV. Provider business mailing address

4255 A1A S STE 11 PMB 136
ST AUGUSTINE FL
32080-8052
US

V. Phone/Fax

Practice location:
  • Phone: 954-647-5737
  • Fax:
Mailing address:
  • Phone: 954-647-5737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: