Healthcare Provider Details

I. General information

NPI: 1326610403
Provider Name (Legal Business Name): ALEXA KAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N BROADWAY APT 2B
YONKERS NY
10701-7064
US

IV. Provider business mailing address

6019 61ST ST
MASPETH NY
11378-3519
US

V. Phone/Fax

Practice location:
  • Phone: 718-866-4569
  • Fax:
Mailing address:
  • Phone: 917-648-0418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: