Provider Demographics
NPI:1104215243
Name:MIZRAHI, ALEXANDRA (PSYD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MIZRAHI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:
Other - Last Name:MIZRAHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:148 COLLEGE ST STE 202C
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8476
Mailing Address - Country:US
Mailing Address - Phone:802-318-4811
Mailing Address - Fax:
Practice Address - Street 1:148 COLLEGE ST STE 202C
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8476
Practice Address - Country:US
Practice Address - Phone:802-318-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004367103TC0700X
VT048.0134171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical