Provider Demographics
NPI:1013354075
Name:BRINK, ALEXANDRA E
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:E
Last Name:BRINK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALEXANDRA
Other - Middle Name:E
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5712 E LIBERTY BLVD
Mailing Address - Street 2:APT 5
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-2453
Mailing Address - Country:US
Mailing Address - Phone:814-952-8621
Mailing Address - Fax:
Practice Address - Street 1:5712 E LIBERTY BLVD
Practice Address - Street 2:APT 5
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-2453
Practice Address - Country:US
Practice Address - Phone:814-952-8621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
PAPC009111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator