Provider Demographics
NPI:1588186506
Name:ABROTT, ALEXANDRA MELISSA (CADC, INTERN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MELISSA
Last Name:ABROTT
Suffix:
Gender:F
Credentials:CADC, INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 ELKO AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-3414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 S PRATT AVE
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4730
Practice Address - Country:US
Practice Address - Phone:775-882-3945
Practice Address - Fax:775-882-6126
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV02138-I171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty