Provider Demographics
NPI:1508292541
Name:SASSAMAN, ALEXANDRA (PSYD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:SASSAMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 BLACKEYED SUSAN PATH
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-8900
Mailing Address - Country:US
Mailing Address - Phone:315-440-6347
Mailing Address - Fax:
Practice Address - Street 1:22100 108TH AVE E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8871
Practice Address - Country:US
Practice Address - Phone:520-261-2579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2022-11-29
Deactivation Date:2020-06-26
Deactivation Code:
Reactivation Date:2022-11-29
Provider Licenses
StateLicense IDTaxonomies
WA504072J103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool