Provider Demographics
NPI:1033985874
Name:GROSSMAN, ALEXA RAE (LSW, LCACA)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:RAE
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:LSW, LCACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13578 E 131ST ST STE 260
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-6401
Mailing Address - Country:US
Mailing Address - Phone:317-620-1102
Mailing Address - Fax:
Practice Address - Street 1:13578 E 131ST ST STE 260
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-6401
Practice Address - Country:US
Practice Address - Phone:317-620-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87900078A101YA0400X
IN33011227A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)