Healthcare Provider Details

I. General information

NPI: 1649114687
Provider Name (Legal Business Name): MRS. DESSE-ANNA ALEXIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DOGWOOD RD
VALLEY STREAM NY
11580-4002
US

IV. Provider business mailing address

200 DOGWOOD RD
VALLEY STREAM NY
11580-4002
US

V. Phone/Fax

Practice location:
  • Phone: 347-461-1638
  • Fax:
Mailing address:
  • Phone: 347-461-1638
  • Fax: 347-461-1638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: