Healthcare Provider Details

I. General information

NPI: 1639034358
Provider Name (Legal Business Name): ALEXA WEISSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 GNARLED HOLLOW RD
SETAUKET NY
11733-1931
US

IV. Provider business mailing address

111 GNARLED HOLLOW RD
SETAUKET NY
11733-1931
US

V. Phone/Fax

Practice location:
  • Phone: 631-487-4016
  • Fax:
Mailing address:
  • Phone: 631-487-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number124460
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: