MEDICARE: ALEXANDRA A KHOOBANI MSW

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	010158	CT
2	1041C0700X	Clinical Social Worker	091299	NY

General Provider Information

NPI Number	:	1386052744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA A KHOOBANI MSW

Provider Business Mailing Address
First Line	:	129 COACHLIGHT SQ
Second Line	:
City	:	MONTROSE
State	:	NY
Zip	:	10548-1250
Country	:	US
Telephone Number	:	203-794-4741
Fax Number	:

Provider Business Practice Location Address
First Line	:	2125 ALBANY POST RD STE 203
Second Line	:
City	:	MONTROSE
State	:	NY
Zip	:	10548-1447
Country	:	US
Telephone Number	:	203-794-4741
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2014
Last Update Date	:	09/24/2021

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