Provider Demographics
NPI:1922331123
Name:SOLODYNA, ALEXANDER (PSYD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:SOLODYNA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SPRING STREET
Mailing Address - Street 2:SUITE 215
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472
Mailing Address - Country:US
Mailing Address - Phone:617-690-9645
Mailing Address - Fax:844-238-9457
Practice Address - Street 1:40 SPRING STREET
Practice Address - Street 2:SUITE 215
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472
Practice Address - Country:US
Practice Address - Phone:617-690-9645
Practice Address - Fax:844-238-9457
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9820103TC0700X
101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health