Provider Demographics
NPI:1932195260
Name:LONC, ALEXANDRA ANN (LCSW, MAC, CGAC)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:ANN
Last Name:LONC
Suffix:
Gender:F
Credentials:LCSW, MAC, CGAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 NW 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4404
Mailing Address - Country:US
Mailing Address - Phone:954-540-6335
Mailing Address - Fax:954-429-8338
Practice Address - Street 1:2151 W. HILLSBORO BLVD.
Practice Address - Street 2:211
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1275
Practice Address - Country:US
Practice Address - Phone:954-540-6335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW71261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11640088OtherCAQH ID