Provider Demographics
NPI:1114429958
Name:ALTMAN, ALEXIS ELEANOR (LICSW)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ELEANOR
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON ST STE 468
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1629
Mailing Address - Country:US
Mailing Address - Phone:617-965-6700
Mailing Address - Fax:
Practice Address - Street 1:2000 WASHINGTON ST STE 468
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1629
Practice Address - Country:US
Practice Address - Phone:617-965-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2229021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical