MEDICARE: ALEXANDRA BERMUDEZ 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	104100000X	Social Worker	105261	NY
2	1041C0700X	Clinical Social Worker	093915	NY

General Provider Information

NPI Number	:	1720648553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA BERMUDEZ LCSW

Provider Business Mailing Address
First Line	:	10162 LEFFERTS BLVD
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-2006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10162 LEFFERTS BLVD
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-2006
Country	:	US
Telephone Number	:	917-434-4252
Fax Number	:

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

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	11/08/2024

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