Healthcare Provider Details

I. General information

NPI: 1619829397
Provider Name (Legal Business Name): ALEXANDRA THEVENIN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 ELLISON ST
PATERSON NJ
07505-1394
US

IV. Provider business mailing address

1606 FERNOTE ST FL 2
RAHWAY NJ
07065-3437
US

V. Phone/Fax

Practice location:
  • Phone: 917-689-9849
  • Fax:
Mailing address:
  • Phone: 917-689-9849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: