Provider Demographics
NPI:1578322400
Name:IRENE, ALEXIS VICTORIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:VICTORIA
Last Name:IRENE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:VICTORIA
Other - Last Name:PRAVDIUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 TIMBER ROCK TRL
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-2260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 TIMBER ROCK TRL
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2260
Practice Address - Country:US
Practice Address - Phone:215-264-3188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01008300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional