Healthcare Provider Details

I. General information

NPI: 1295462000
Provider Name (Legal Business Name): ALEXANDRA MARSICO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2381 HYLAN BLVD STE 13
STATEN ISLAND NY
10306-3145
US

IV. Provider business mailing address

141 S 5TH ST APT 4W
BROOKLYN, NY NY
11211
US

V. Phone/Fax

Practice location:
  • Phone: 800-277-4680
  • Fax:
Mailing address:
  • Phone: 914-787-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110806-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: