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NPI Code Detail

MEDICARE: ALEXANDRIA MARIE BAXTER LCSW

MEDICARE: ALEXANDRIA MARIE BAXTER 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
1104100000XSocial Worker103621NY
21041C0700XClinical Social Worker094991NY

General Provider Information

NPI Number : 1740743152
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRIA MARIE BAXTER LCSW
Provider Business Mailing Address
First Line : 248 BAY AVE
Second Line :
City : PATCHOGUE
State : NY
Zip : 11772-4019
Country : US
Telephone Number : 631-432-9706
Fax Number :
Provider Business Practice Location Address
First Line : 4109 SUNRISE HWY
Second Line :
City : BOHEMIA
State : NY
Zip : 11716-4600
Country : US
Telephone Number : 631-503-1539
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2019
Last Update Date : 03/29/2023

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