Provider Demographics
NPI:1740526813
Name:LO RE, ALEXANDRA HELEN (LMSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:HELEN
Last Name:LO RE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 211TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1809
Mailing Address - Country:US
Mailing Address - Phone:718-810-1596
Mailing Address - Fax:
Practice Address - Street 1:5319 211TH ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE HILLS
Practice Address - State:NY
Practice Address - Zip Code:11364-1809
Practice Address - Country:US
Practice Address - Phone:718-810-1596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087144-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker