Provider Demographics
NPI:1023552007
Name:VIGLUCCI, ALEXANDRA
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:
Last Name:VIGLUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ACADEMY RD
Mailing Address - Street 2:FULLER BUILDING
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3103
Mailing Address - Country:US
Mailing Address - Phone:518-426-2730
Mailing Address - Fax:
Practice Address - Street 1:60 ACADEMY RD
Practice Address - Street 2:FULLER BUILDING
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3103
Practice Address - Country:US
Practice Address - Phone:518-426-2730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098952104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker