Provider Demographics
NPI:1336227727
Name:CHASE, ALEXANDRA N
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:N
Last Name:CHASE
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 1:544 VISTA MAR AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1950
Mailing Address - Country:US
Mailing Address - Phone:650-302-1395
Mailing Address - Fax:650-355-6752
Practice Address - Street 1:80 EUREKA SQ STE 213
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2677
Practice Address - Country:US
Practice Address - Phone:650-302-1395
Practice Address - Fax:650-355-6752
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18562103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL185621Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST