Provider Demographics
NPI:1215553169
Name:TAVERAS, ALEXA (MSW)
Entity Type:Individual
Prefix:MISS
First Name:ALEXA
Middle Name:
Last Name:TAVERAS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W 15TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6701
Mailing Address - Country:US
Mailing Address - Phone:212-924-6320
Mailing Address - Fax:646-306-0513
Practice Address - Street 1:28 DEBEVOISE ST STE 5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4194
Practice Address - Country:US
Practice Address - Phone:718-963-4430
Practice Address - Fax:646-398-2794
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
NY111020104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool