Provider Demographics
NPI:1578656856
Name:ALEXANDER, ROME (LICSW)
Entity Type:Individual
Prefix:
First Name:ROME
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7616 CURRELL BLVD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2290
Mailing Address - Country:US
Mailing Address - Phone:612-280-0148
Mailing Address - Fax:651-735-7527
Practice Address - Street 1:7616 CURRELL BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2290
Practice Address - Country:US
Practice Address - Phone:612-280-0148
Practice Address - Fax:651-735-7527
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN70421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical