Provider Demographics
NPI:1710749973
Name:UNDERWOOD, ALEXANDER R
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:R
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 INNES AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1761
Mailing Address - Country:US
Mailing Address - Phone:813-550-9670
Mailing Address - Fax:
Practice Address - Street 1:4541 INNES AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-1761
Practice Address - Country:US
Practice Address - Phone:813-550-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician