Provider Demographics
NPI:1376780577
Name:PHILLIPPE, ALEXANDRA ALDEN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:ALDEN
Last Name:PHILLIPPE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-9461
Mailing Address - Country:US
Mailing Address - Phone:650-387-8545
Mailing Address - Fax:
Practice Address - Street 1:2000 DWIGHT WAY
Practice Address - Street 2:SUITE D
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2639
Practice Address - Country:US
Practice Address - Phone:650-387-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-10
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46609106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist