Provider Demographics
NPI:1770169906
Name:CZYWCZYNSKI, ALEXANDRA WERNTZ (PHD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:WERNTZ
Last Name:CZYWCZYNSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:WERNTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:618 7 1/2 ST SW
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-3809
Mailing Address - Country:US
Mailing Address - Phone:703-517-6243
Mailing Address - Fax:
Practice Address - Street 1:675 PETER JEFFERSON PKWY STE 130
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8618
Practice Address - Country:US
Practice Address - Phone:703-517-6243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007407103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical