Provider Demographics
NPI:1982268264
Name:ALEXANDRE, GLAVEDIA M (RN)
Entity Type:Individual
Prefix:MRS
First Name:GLAVEDIA
Middle Name:M
Last Name:ALEXANDRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3515
Mailing Address - Country:US
Mailing Address - Phone:973-474-0332
Mailing Address - Fax:
Practice Address - Street 1:10 OREGON ST
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3515
Practice Address - Country:US
Practice Address - Phone:973-474-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities