MEDICARE: ALEXANDRA A LONC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW 7126	FL

General Provider Information

NPI Number	:	1356535710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXANDRA A LONC PA

Provider Business Mailing Address
First Line	:	1300 E HILLSBORO BLVD
Second Line	:	201
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4235
Country	:	US
Telephone Number	:	954-540-6335
Fax Number	:	954-429-8338

Provider Business Practice Location Address
First Line	:	1300 E HILLSBORO BLVD
Second Line	:	201
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4235
Country	:	US
Telephone Number	:	954-540-6335
Fax Number	:	954-429-8338

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MS. ALEXANDRA ANN LONC
Credential	:	LCSW, CAP, CST, CFAE
Telephone Number	:	954-540-6335

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	02/05/2013

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