Provider Demographics
NPI:1376809756
Name:BELTOWSKI, ALEXANDRA ELIZABETH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:BELTOWSKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18303 E 10 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4989
Mailing Address - Country:US
Mailing Address - Phone:800-693-1916
Mailing Address - Fax:248-605-3525
Practice Address - Street 1:18303 E 10 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4989
Practice Address - Country:US
Practice Address - Phone:800-693-1916
Practice Address - Fax:248-605-3525
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801095805104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker