Healthcare Provider Details

I. General information

NPI: 1578355590
Provider Name (Legal Business Name): ALEXANDRA MARIE FEBUS MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S 40TH ST STE 201B
PHILADELPHIA PA
19104-5827
US

IV. Provider business mailing address

PO BOX 748465
ATLANTA GA
30374-8465
US

V. Phone/Fax

Practice location:
  • Phone: 855-675-4010
  • Fax: 617-807-0958
Mailing address:
  • Phone: 855-284-7483
  • Fax: 617-807-0958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC016483
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: