Healthcare Provider Details

I. General information

NPI: 1063050391
Provider Name (Legal Business Name): ANGEL ALEXION MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SE OCEAN BLVD STE 340
STUART FL
34994-3502
US

IV. Provider business mailing address

9354 KETAY CIR
BOCA RATON FL
33428-1519
US

V. Phone/Fax

Practice location:
  • Phone: 772-220-3439
  • Fax:
Mailing address:
  • Phone: 561-305-8437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW23464
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: