Provider Demographics
NPI:1922723063
Name:KACZMARSKI, ALEXA DIANE (LCSW, MED)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:DIANE
Last Name:KACZMARSKI
Suffix:
Gender:F
Credentials:LCSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ROSSMORE RD APT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3850
Mailing Address - Country:US
Mailing Address - Phone:609-760-8651
Mailing Address - Fax:
Practice Address - Street 1:16 ROSSMORE RD APT 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3850
Practice Address - Country:US
Practice Address - Phone:609-760-8651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2285631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical