Provider Demographics
NPI:1164015475
Name:BLEICH, ALEXANDRIA N (LPC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:N
Last Name:BLEICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 PARK AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1754
Mailing Address - Country:US
Mailing Address - Phone:732-300-0952
Mailing Address - Fax:
Practice Address - Street 1:567 PARK AVE STE 204
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1754
Practice Address - Country:US
Practice Address - Phone:908-242-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NJAC-GTL-21-02162.101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37PC001017200Medicaid