Provider Demographics
NPI:1235746934
Name:ALEXANDRA R NELSON PHD
Entity Type:Organization
Organization Name:ALEXANDRA R NELSON PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-550-3639
Mailing Address - Street 1:46 GERALD RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-4769
Mailing Address - Country:US
Mailing Address - Phone:860-550-3639
Mailing Address - Fax:
Practice Address - Street 1:46 GERALD RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-4769
Practice Address - Country:US
Practice Address - Phone:860-550-3639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty