Provider Demographics
NPI:1710149505
Name:SULLIVAN, ALEXANDRA ELIZABETH (MSW)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WESTCHESTER SQ
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3525
Mailing Address - Country:US
Mailing Address - Phone:718-931-4045
Mailing Address - Fax:718-828-1318
Practice Address - Street 1:1138 54TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4137
Practice Address - Country:US
Practice Address - Phone:914-329-5877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker