Healthcare Provider Details

I. General information

NPI: 1538726443
Provider Name (Legal Business Name): ALIX BIRDOFF HENICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALIX BIRDOFF LCSW

II. Dates (important events)

Enumeration Date: 05/27/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MILTON ST
BROOKLYN NY
11222-2501
US

IV. Provider business mailing address

125 MILTON ST
BROOKLYN NY
11222-2501
US

V. Phone/Fax

Practice location:
  • Phone: 914-500-5334
  • Fax:
Mailing address:
  • Phone: 914-500-5334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number094591
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109891
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number098165-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: