Provider Demographics
NPI:1295200707
Name:RUCHEL, ALEXA JORDYN (MSW INTERN)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:JORDYN
Last Name:RUCHEL
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 COOPER HILL RD # 219
Mailing Address - Street 2:
Mailing Address - City:WYNANTSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12198-2906
Mailing Address - Country:US
Mailing Address - Phone:518-283-6500
Mailing Address - Fax:
Practice Address - Street 1:614 COOPER HILL RD # 219
Practice Address - Street 2:
Practice Address - City:WYNANTSKILL
Practice Address - State:NY
Practice Address - Zip Code:12198-2906
Practice Address - Country:US
Practice Address - Phone:518-283-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program