Healthcare Provider Details

I. General information

NPI: 1134047251
Provider Name (Legal Business Name): ALEXANDRA JANE YOUNGSMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BELMONT ST
BROCKTON MA
02301-5596
US

IV. Provider business mailing address

940 BELMONT ST
BROCKTON MA
02301-5596
US

V. Phone/Fax

Practice location:
  • Phone: 774-826-1361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW2141339
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: