Provider Demographics
NPI:1932717543
Name:DEROSA, ALEXANDRA LAUREN (LMSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LAUREN
Last Name:DEROSA
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 1:3810 ROSIN CT STE 180
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1656
Mailing Address - Country:US
Mailing Address - Phone:916-283-8280
Mailing Address - Fax:
Practice Address - Street 1:3810 ROSIN CT STE 180
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1656
Practice Address - Country:US
Practice Address - Phone:916-283-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106091104100000X
171M00000X
CA97981104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator