Healthcare Provider Details

I. General information

NPI: 1033663083
Provider Name (Legal Business Name): ALEXANDRA MICHELLE BASHKOFF MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 SANTA ROSA RD
RICHMOND VA
23229-5105
US

IV. Provider business mailing address

1601 N 31ST ST
RICHMOND VA
23223-5404
US

V. Phone/Fax

Practice location:
  • Phone: 804-781-9028
  • Fax: 804-998-2008
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number090648
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012761
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: