Healthcare Provider Details

I. General information

NPI: 1891380697
Provider Name (Legal Business Name): ALEKSANDRA PLOCHA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 BAXTER ST APT 4
SOUTH BOSTON MA
02127-2569
US

IV. Provider business mailing address

40 BAXTER ST APT 4
SOUTH BOSTON MA
02127-2569
US

V. Phone/Fax

Practice location:
  • Phone: 610-291-2092
  • Fax:
Mailing address:
  • Phone: 610-291-2092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number10911
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: