Provider Demographics
NPI:1073904991
Name:ALEXANDRA STRACK, LLC
Entity Type:Organization
Organization Name:ALEXANDRA STRACK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:PAIGE LIBON
Authorized Official - Last Name:STRACK
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:781-773-8770
Mailing Address - Street 1:17 CAZENOVE ST
Mailing Address - Street 2:404
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-6234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 COMMONWEALTH AVE
Practice Address - Street 2:SUITE 906
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2349
Practice Address - Country:US
Practice Address - Phone:781-773-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN22722000261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)