Provider Demographics
NPI:1245928985
Name:PAINO, ALEXANDRA ELISABETH
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ELISABETH
Last Name:PAINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 STATE ROUTE 17M STE 4
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-3444
Mailing Address - Country:US
Mailing Address - Phone:570-483-8673
Mailing Address - Fax:
Practice Address - Street 1:360 STATE ROUTE 17M STE 4
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-3444
Practice Address - Country:US
Practice Address - Phone:570-483-8673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013468101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor