Healthcare Provider Details

I. General information

NPI: 1083359426
Provider Name (Legal Business Name): ALEXANDRA ZIPKIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2022
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 N 10TH ST STE 31
BROOKLYN NY
11211-9325
US

IV. Provider business mailing address

184 MESEROLE ST # 2
BROOKLYN NY
11206-2128
US

V. Phone/Fax

Practice location:
  • Phone: 646-779-7172
  • Fax:
Mailing address:
  • Phone: 203-803-7460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number013475
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: