Provider Demographics
NPI:1255486841
Name:SCHONROG, ALEXIS T (LICSW)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:T
Last Name:SCHONROG
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 1:45B BUCKEYE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-2702
Mailing Address - Country:US
Mailing Address - Phone:401-741-8206
Mailing Address - Fax:401-596-8802
Practice Address - Street 1:45B BUCKEYE BROOK RD
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-2702
Practice Address - Country:US
Practice Address - Phone:401-741-8206
Practice Address - Fax:866-387-6480
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW018481041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAD51685Medicaid
RIAD51685Medicaid