Provider Demographics
NPI:1407227333
Name:PATRICK, ALEXANDRIA (DSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:
Other - Last Name:BOHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 PASSAVANT WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-1318
Mailing Address - Country:US
Mailing Address - Phone:412-820-1015
Mailing Address - Fax:
Practice Address - Street 1:89 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1663
Practice Address - Country:US
Practice Address - Phone:412-820-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130407101YM0800X, 106H00000X, 104100000X
PACW0202141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW130407Medicaid