Provider Demographics
NPI:1235618463
Name:STATE, ALEXA
Entity Type:Individual
Prefix:MISS
First Name:ALEXA
Middle Name:
Last Name:STATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 JODIRO LN APT 101
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-2551
Mailing Address - Country:US
Mailing Address - Phone:315-853-6090
Mailing Address - Fax:315-853-3190
Practice Address - Street 1:678 TROY SCHENECTADY RD STE 201
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2503
Practice Address - Country:US
Practice Address - Phone:315-853-6090
Practice Address - Fax:315-853-3190
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator