Provider Demographics
NPI:1679227086
Name:WALLERSTEIN, ALEXA ROSE (LMHC)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:ROSE
Last Name:WALLERSTEIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 6TH ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-7219
Mailing Address - Country:US
Mailing Address - Phone:973-617-7628
Mailing Address - Fax:
Practice Address - Street 1:181 E 73RD ST APT 14D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3573
Practice Address - Country:US
Practice Address - Phone:929-297-9753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health