Provider Demographics
NPI:1508071721
Name:BRITO, ALEJANDRINA (CSAC)
Entity Type:Individual
Prefix:MS
First Name:ALEJANDRINA
Middle Name:
Last Name:BRITO
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 S 115TH CT APT 4
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3780
Mailing Address - Country:US
Mailing Address - Phone:414-546-6880
Mailing Address - Fax:414-546-6234
Practice Address - Street 1:9330 W LINCOLN AVE STE 21
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2300
Practice Address - Country:US
Practice Address - Phone:414-546-6880
Practice Address - Fax:414-546-6234
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11636-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39177400Medicaid