MEDICARE: ALEXANDRA LIN MACY LCSW

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	089.0131922	VT

General Provider Information

NPI Number	:	1699273565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA LIN MACY LCSW

Provider Business Mailing Address
First Line	:	5 CORLISS AVE
Second Line	:
City	:	GREENWICH
State	:	NY
Zip	:	12834-1003
Country	:	US
Telephone Number	:	518-260-4763
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 PINE HAVEN SHORES RD STE 1000A
Second Line	:
City	:	SHELBURNE
State	:	VT
Zip	:	05482-7812
Country	:	US
Telephone Number	:	775-553-8007
Fax Number	:

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

Provider Enumeration Date	:	01/25/2018
Last Update Date	:	10/18/2023

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