Provider Demographics
NPI:1639491723
Name:PEDICONE, ALEXANDER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:PEDICONE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 HIGHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1433
Mailing Address - Country:US
Mailing Address - Phone:201-312-5847
Mailing Address - Fax:201-447-2504
Practice Address - Street 1:356 HIGHWOOD AVE
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1433
Practice Address - Country:US
Practice Address - Phone:201-312-5847
Practice Address - Fax:201-447-2504
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC043001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical