Provider Demographics
NPI:1386031698
Name:KLEIN, ALEXA BRYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALEXA
Middle Name:BRYNN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 S GREENE AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-5430
Mailing Address - Country:US
Mailing Address - Phone:516-851-4311
Mailing Address - Fax:
Practice Address - Street 1:100 QUENTIN ROOSEVELT BLVD STE 300
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4843
Practice Address - Country:US
Practice Address - Phone:516-838-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093235104100000X
NY0879841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker