Healthcare Provider Details

I. General information

NPI: 1962327239
Provider Name (Legal Business Name): ALEXA RAE NOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 THEODORE FREMD AVE STE 206
RYE NY
10580-1411
US

IV. Provider business mailing address

16 RIVER ST
TUCKAHOE NY
10707-3309
US

V. Phone/Fax

Practice location:
  • Phone: 914-336-9281
  • Fax: 877-929-2508
Mailing address:
  • Phone: 914-306-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: