Provider Demographics
NPI:1740387828
Name:ALEXANDER PROFESSIONAL
Entity Type:Organization
Organization Name:ALEXANDER PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-296-2809
Mailing Address - Street 1:PO BOX 1474
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-0028
Mailing Address - Country:US
Mailing Address - Phone:330-296-2809
Mailing Address - Fax:330-296-2800
Practice Address - Street 1:2633 STATE ROUTE 59
Practice Address - Street 2:SUITE E
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-1684
Practice Address - Country:US
Practice Address - Phone:330-296-2829
Practice Address - Fax:330-541-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3504103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0450962Medicaid
OHR71258Medicare UPIN
OH0450962Medicaid