Provider Demographics
NPI:1619385705
Name:DEVIN, ALEXANDRA SALLESE (LCAT)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:SALLESE
Last Name:DEVIN
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:MS
Other - First Name:ALEXANDRA
Other - Middle Name:DEVIN
Other - Last Name:VICICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCAT
Mailing Address - Street 1:55 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-3929
Mailing Address - Country:US
Mailing Address - Phone:347-730-7356
Mailing Address - Fax:
Practice Address - Street 1:55 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-3929
Practice Address - Country:US
Practice Address - Phone:347-730-7356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001794-01101200000X
NY001794221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist