Provider Demographics
NPI:1073045464
Name:ALEXANDER, DIANE MAJORIE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MAJORIE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:MARJORIE
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CASAC
Mailing Address - Street 1:55 TROUP ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-2053
Mailing Address - Country:US
Mailing Address - Phone:585-546-1271
Mailing Address - Fax:585-546-2607
Practice Address - Street 1:55 TROUP ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2053
Practice Address - Country:US
Practice Address - Phone:585-546-1271
Practice Address - Fax:585-546-2607
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5293101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)