Provider Demographics
NPI:1851959282
Name:MASTERSON, ALEXANDRA MICHELE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:MICHELE
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:ALEXANDRA
Other - Middle Name:MICHELE
Other - Last Name:PINOTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4400 W 95TH ST STE 205
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2658
Practice Address - Country:US
Practice Address - Phone:708-684-5340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1490209671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical