Provider Demographics
NPI:1902427768
Name:SHOLTIS, ALEXIS (LICSW)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:SHOLTIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 CALVARY ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-8366
Mailing Address - Country:US
Mailing Address - Phone:860-921-3493
Mailing Address - Fax:
Practice Address - Street 1:330 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:617-499-5811
Practice Address - Fax:617-499-5419
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1231091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical