Provider Demographics
NPI:1841804267
Name:JOLLY, ALEXANDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:JOLLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 VIA VERMILYA APT 404
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2440
Mailing Address - Country:US
Mailing Address - Phone:914-584-5328
Mailing Address - Fax:
Practice Address - Street 1:5917 VIA VERMILYA APT 404
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-2440
Practice Address - Country:US
Practice Address - Phone:914-584-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW173571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical