Provider Demographics
NPI:1982237053
Name:ALEXANDRA CORRIVEAU LLC
Entity Type:Organization
Organization Name:ALEXANDRA CORRIVEAU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRIVEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-576-8236
Mailing Address - Street 1:55 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-5130
Mailing Address - Country:US
Mailing Address - Phone:860-576-8236
Mailing Address - Fax:860-786-7932
Practice Address - Street 1:387C TUCKIE RD
Practice Address - Street 2:
Practice Address - City:NORTH WINDHAM
Practice Address - State:CT
Practice Address - Zip Code:06256-1370
Practice Address - Country:US
Practice Address - Phone:860-576-8236
Practice Address - Fax:860-786-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty