Provider Demographics
NPI:1619069952
Name:MYLES, ALEXANDRA L (LICSW #100605)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:L
Last Name:MYLES
Suffix:
Gender:F
Credentials:LICSW #100605
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:250 BRATTLE ST
Mailing Address - Street 2:UNIT #22
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4631
Mailing Address - Country:US
Mailing Address - Phone:617-497-0190
Mailing Address - Fax:617-497-0190
Practice Address - Street 1:250 BRATTLE ST
Practice Address - Street 2:UNIT #22
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4631
Practice Address - Country:US
Practice Address - Phone:617-497-0190
Practice Address - Fax:617-497-0190
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1006051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical