Provider Demographics
NPI:1871014100
Name:SUTHERLAND, ALEXA JANE LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:JANE LEE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9 KEITH CIR
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419-1453
Mailing Address - Country:US
Mailing Address - Phone:203-215-0253
Mailing Address - Fax:
Practice Address - Street 1:300 CHURCH ST
Practice Address - Street 2:
Practice Address - City:YALESVILLE
Practice Address - State:CT
Practice Address - Zip Code:06492-2253
Practice Address - Country:US
Practice Address - Phone:203-679-0849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT98061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical