Provider Demographics
NPI:1467973644
Name:QUINN, ALEXANDRA MANGO (LMHC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MANGO
Last Name:QUINN
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:ROSE
Other - Last Name:MANGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 INNERBELT RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1385 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-3414
Practice Address - Country:US
Practice Address - Phone:978-256-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MALMHC5000952101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor