Healthcare Provider Details

I. General information

NPI: 1871497867
Provider Name (Legal Business Name): ALEXANDRA GREEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 33RD ST STE 502
ASTORIA NY
11106-2329
US

IV. Provider business mailing address

756 MYRTLE AVE APT 2K
BROOKLYN NY
11206-5513
US

V. Phone/Fax

Practice location:
  • Phone: 718-426-8110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116520
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: