Provider Demographics
NPI:1750151783
Name:WEINTRAUB, ALEXANDRA CAROL
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:CAROL
Last Name:WEINTRAUB
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 1:51 MONROE ST APT 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7358
Mailing Address - Country:US
Mailing Address - Phone:647-456-8178
Mailing Address - Fax:
Practice Address - Street 1:4 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4567
Practice Address - Country:US
Practice Address - Phone:212-553-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121877104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker