Provider Demographics
NPI:1023387651
Name:RUNDE, ALEXANDRA (MED)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:
Last Name:RUNDE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 ST. LUCIE WEST BLVD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986
Mailing Address - Country:US
Mailing Address - Phone:772-812-0292
Mailing Address - Fax:772-878-7218
Practice Address - Street 1:1555 ST. LUCIE WEST BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986
Practice Address - Country:US
Practice Address - Phone:772-812-0292
Practice Address - Fax:772-878-7218
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health