Provider Demographics
NPI:1649881541
Name:KONKO, ALEXIA M
Entity type:Individual
Prefix:
First Name:ALEXIA
Middle Name:M
Last Name:KONKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 ENGLISHTOWN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3903
Mailing Address - Country:US
Mailing Address - Phone:732-361-2914
Mailing Address - Fax:
Practice Address - Street 1:1816 ENGLISHTOWN RD
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3903
Practice Address - Country:US
Practice Address - Phone:732-361-2914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist