Healthcare Provider Details

I. General information

NPI: 1417420373
Provider Name (Legal Business Name): ALEXANDRA GOLOB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 HEIGHTS RD
PARAMUS NJ
07652-3350
US

IV. Provider business mailing address

530 GREGORY AVE APT C216
WEEHAWKEN NJ
07086-5745
US

V. Phone/Fax

Practice location:
  • Phone: 561-866-0633
  • Fax:
Mailing address:
  • Phone: 561-866-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number090893
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06000700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: