Provider Demographics
NPI:1619025111
Name:PRIOR, ALEX T (LICSW)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:T
Last Name:PRIOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GROVE ST.
Mailing Address - Street 2:SUITE 303 - GROVE STREET COUNSELING
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01862-7741
Mailing Address - Country:US
Mailing Address - Phone:781-431-7323
Mailing Address - Fax:
Practice Address - Street 1:8 GROVE ST.
Practice Address - Street 2:SUITE 303 - GROVE STREET COUNSELING
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:01862-7741
Practice Address - Country:US
Practice Address - Phone:781-431-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1063461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA106346OtherLICENSED INDEPENDENT SOCI
MA986020OtherBLUE CROSS PROVIDER NUMBE
MA106346OtherLICENSED INDEPENDENT SOCI