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General NPI Number Information
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NPI Number | 1194115147
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Entity Type | Individual
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Provider Name | ALEXA SQUIRE LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 297 KINDERKAMACK RD SUITE 212
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City | ORADELL
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State | NJ
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Zip | 07649-1538
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Country | US
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Telephone | 201-739-2216
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Fax |
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Provider Business Mailing Address
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Address Line | 53 FLAMING ARROW RD
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City | MAHWAH
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State | NJ
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Zip | 07430-1354
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Country | US
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Telephone | 201-739-2216
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 37FI00176600
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License Number State | NJ
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