Provider Demographics
NPI:1295033710
Name:TELEWODA, ALEX (THERAPIST)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:TELEWODA
Suffix:
Gender:M
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FEDERAL ST
Mailing Address - Street 2:SUITE 227
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1061
Mailing Address - Country:US
Mailing Address - Phone:855-447-1351
Mailing Address - Fax:
Practice Address - Street 1:200 FEDERAL ST
Practice Address - Street 2:SUITE 227
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1061
Practice Address - Country:US
Practice Address - Phone:855-447-1351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor