Provider Demographics
NPI:1609041763
Name:BRILL, ALEXA RUTH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALEXA
Middle Name:RUTH
Last Name:BRILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 QUEENS BLVD
Mailing Address - Street 2:APT. L5C
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3629
Mailing Address - Country:US
Mailing Address - Phone:212-439-1158
Mailing Address - Fax:
Practice Address - Street 1:102-45 67TH ROAD
Practice Address - Street 2:APT. 1T
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2628
Practice Address - Country:US
Practice Address - Phone:212-439-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03094311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical