Healthcare Provider Details

I. General information

NPI: 1255277026
Provider Name (Legal Business Name): ALEXIS TOBUREN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 DEER PATH DR
BERWICK PA
18603-5108
US

IV. Provider business mailing address

21 S 4TH ST
SOUDERTON PA
18964-1513
US

V. Phone/Fax

Practice location:
  • Phone: 570-293-9374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW025714
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: