=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528733151
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALEXA WERNICK PSYCHOTHERAPY LCSW PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2021
-----------------------------------------------------
Last Update Date | 08/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 E 18TH ST APT 11K
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-2458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-460-4499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1806 PINE HILL DR
-----------------------------------------------------
City | SAFETY HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34695-5224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-460-4499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. ALEXA WERNICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-460-4499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------