Provider Demographics
NPI:1649488495
Name:ALEXANDER, JACQUELINE MARIE (MA, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MARIE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:WEST SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06092-0404
Mailing Address - Country:US
Mailing Address - Phone:860-408-1595
Mailing Address - Fax:860-693-4452
Practice Address - Street 1:244 FARMS VILLAGE ROAD
Practice Address - Street 2:
Practice Address - City:WEST SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06092
Practice Address - Country:US
Practice Address - Phone:860-693-4599
Practice Address - Fax:860-693-4452
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001364101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional