Provider Demographics
NPI:1972876167
Name:ALEXANDER, DIANE MARIE
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARIE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:131 W BROAD ST
Mailing Address - Street 2:RCSD
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14614-1103
Mailing Address - Country:US
Mailing Address - Phone:585-262-8346
Mailing Address - Fax:585-935-7478
Practice Address - Street 1:131 WEST BROAD STREET
Practice Address - Street 2:RCSD
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614
Practice Address - Country:US
Practice Address - Phone:585-262-8346
Practice Address - Fax:585-935-7478
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082281-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool