Healthcare Provider Details

I. General information

NPI: 1316273055
Provider Name (Legal Business Name): ALEXIS LAKE MSS, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXIS LAKE

II. Dates (important events)

Enumeration Date: 11/01/2009
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 HARRISBURG AVE STE 9
LANCASTER PA
17603-2652
US

IV. Provider business mailing address

931 HARRISBURG AVE STE 9
LANCASTER PA
17603-2652
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-9051
  • Fax: 717-735-9234
Mailing address:
  • Phone: 717-544-9051
  • Fax: 717-735-9234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW127241
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW019825
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: