Provider Demographics
NPI:1134659634
Name:RESTUCCIA, ALEXANDRA BROOKE
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:BROOKE
Last Name:RESTUCCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:BROOKE
Other - Last Name:AKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9223 GOODWILL CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-1874
Mailing Address - Country:US
Mailing Address - Phone:978-503-2320
Mailing Address - Fax:
Practice Address - Street 1:9223 GOODWILL CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-1874
Practice Address - Country:US
Practice Address - Phone:978-503-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist