Provider Demographics
NPI:1316189699
Name:ALEXANDER, KIM VINCENT (069820)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:VINCENT
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:069820
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 E68 ST 3P
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-746-1252
Mailing Address - Fax:212-746-7951
Practice Address - Street 1:445 E 68 ST 3P
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-746-1252
Practice Address - Fax:212-746-7951
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0698201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY069820OtherNYS DEPT. OF EDUCATION