Provider Demographics
NPI:1609531003
Name:GAVRILOV, ALEXA BRIANA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALEXA
Middle Name:BRIANA
Last Name:GAVRILOV
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 1:140 YORKSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2112
Mailing Address - Country:US
Mailing Address - Phone:267-397-6226
Mailing Address - Fax:
Practice Address - Street 1:140 YORKSHIRE WAY
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2112
Practice Address - Country:US
Practice Address - Phone:267-397-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0236631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical