Healthcare Provider Details

I. General information

NPI: 1366749087
Provider Name (Legal Business Name): LEXIE E LUDOVICI LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 FATHER DEVALLES BLVD
FALL RIVER MA
02723-1519
US

IV. Provider business mailing address

21 FATHER DEVALLES BLVD
FALL RIVER MA
02723-1519
US

V. Phone/Fax

Practice location:
  • Phone: 774-775-2108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number117520
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: