Healthcare Provider Details

I. General information

NPI: 1619898871
Provider Name (Legal Business Name): ALEXIS DYER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 FREEPORT LOOP
BROOKLYN NY
11239-2313
US

IV. Provider business mailing address

1420 FREEPORT LOOP
BROOKLYN NY
11239-2313
US

V. Phone/Fax

Practice location:
  • Phone: 347-543-5368
  • Fax:
Mailing address:
  • Phone: 347-543-5368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number124241
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: