Provider Demographics
NPI:1740355296
Name:DIMANT, ALEXANDRA (LCSW)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:DIMANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2613
Mailing Address - Country:US
Mailing Address - Phone:917-208-8330
Mailing Address - Fax:
Practice Address - Street 1:311 W 50TH ST
Practice Address - Street 2:SUITE A (ACTUAL ADDRESS IS 311A W 50TH ST)
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6621
Practice Address - Country:US
Practice Address - Phone:917-208-8330
Practice Address - Fax:212-479-9441
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730732171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical