Provider Demographics
NPI:1396375218
Name:THEORDOR, ALEXANDRIA (MSW, LCSW, CBIS)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:THEORDOR
Suffix:
Gender:F
Credentials:MSW, LCSW, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2610
Mailing Address - Country:US
Mailing Address - Phone:908-379-8110
Mailing Address - Fax:
Practice Address - Street 1:37 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2610
Practice Address - Country:US
Practice Address - Phone:908-379-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2020-11-09
Deactivation Date:2020-03-25
Deactivation Code:
Reactivation Date:2020-11-05
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057992001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical