Provider Demographics
NPI:1659610491
Name:PSIHOGIOS, ALEXANDRA M (MA)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:M
Last Name:PSIHOGIOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W COLUMBIA AVE
Mailing Address - Street 2:APT 1N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4522
Mailing Address - Country:US
Mailing Address - Phone:240-994-6546
Mailing Address - Fax:
Practice Address - Street 1:1110 W COLUMBIA AVE
Practice Address - Street 2:APT 1N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-4522
Practice Address - Country:US
Practice Address - Phone:240-994-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
PAPS018621103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No252Y00000XAgenciesEarly Intervention Provider Agency