Provider Demographics
NPI:1780219717
Name:RICHARDS, ALEXANDRA ELIZABETH (MS, CGC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:ELIZABETH
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:759 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-0001
Mailing Address - Country:US
Mailing Address - Phone:413-794-8890
Mailing Address - Fax:
Practice Address - Street 1:759 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-0001
Practice Address - Country:US
Practice Address - Phone:413-794-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC513170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS