Provider Demographics
NPI:1578793550
Name:PITT, ALEXANDRA E (MA)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:E
Last Name:PITT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 OLD PECOS TRL STE P
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4759
Mailing Address - Country:US
Mailing Address - Phone:505-795-8447
Mailing Address - Fax:505-213-0337
Practice Address - Street 1:1800 OLD PECOS TRL STE P
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4759
Practice Address - Country:US
Practice Address - Phone:505-795-8447
Practice Address - Fax:505-213-0337
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0142481101YM0800X
NM0161941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health