Provider Demographics
NPI:1558612853
Name:FORWARD, ALEXANDREA JOSEPHINE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDREA
Middle Name:JOSEPHINE
Last Name:FORWARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 ETHAN ALLEN PKWY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-2523
Mailing Address - Country:US
Mailing Address - Phone:917-208-5024
Mailing Address - Fax:
Practice Address - Street 1:86 LAKE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5297
Practice Address - Country:US
Practice Address - Phone:802-865-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.0128888101YP2500X, 101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health