Provider Demographics
NPI:1154899185
Name:WILT, ALEXANDRA RUTH (LCSW, LMSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:RUTH
Last Name:WILT
Suffix:
Gender:F
Credentials:LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E 44TH ST FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-3624
Mailing Address - Country:US
Mailing Address - Phone:513-490-1286
Mailing Address - Fax:
Practice Address - Street 1:9689 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-9547
Practice Address - Country:US
Practice Address - Phone:513-490-1286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0930391041C0700X
OHI.24055061041C0700X
NY105334104100000X
FLSW210331041C0700X
NJ44SC061787001041C0700X
MI68011171221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker