MEDICARE: ALEXIS ASHLEY ANDERSON LMSW

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	130918-01	NY

General Provider Information

NPI Number	:	1932049301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS ASHLEY ANDERSON LMSW

Provider Business Mailing Address
First Line	:	1230 PENNSYLVANIA AVE APT 19B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11239-1114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 PENNSYLVANIA AVE APT 19B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11239-1114
Country	:	US
Telephone Number	:	929-343-2404
Fax Number	:

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

Provider Enumeration Date	:	03/28/2026
Last Update Date	:	03/28/2026

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