Provider Demographics
NPI:1336923028
Name:SMITH, ALEXANDRA GERRA (LLMSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:GERRA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 COOLIDGE HWY APT 121
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1999
Mailing Address - Country:US
Mailing Address - Phone:248-630-5289
Mailing Address - Fax:
Practice Address - Street 1:2219 COOLIDGE HWY APT 121
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1999
Practice Address - Country:US
Practice Address - Phone:248-630-5289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511163221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical