Provider Demographics
NPI:1457151284
Name:GILMORE, ALEXANDRA (LMSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:GILMORE
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3532 JAMES ST STE 112
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2722
Mailing Address - Country:US
Mailing Address - Phone:315-463-9413
Mailing Address - Fax:
Practice Address - Street 1:3532 JAMES ST STE 112
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2722
Practice Address - Country:US
Practice Address - Phone:315-412-2646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114794104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker