Provider Demographics
NPI:1588213953
Name:MIRASSOU, ALEXANDRA ELISABETH
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ELISABETH
Last Name:MIRASSOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:ELISABETH
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-0099
Mailing Address - Country:US
Mailing Address - Phone:209-742-0982
Mailing Address - Fax:
Practice Address - Street 1:5362 LEMEE LN
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-9556
Practice Address - Country:US
Practice Address - Phone:209-742-0982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical