Provider Demographics
NPI:1033956685
Name:LITWAK, ALEXA
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:LITWAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 EMERSON RD
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-3117
Mailing Address - Country:US
Mailing Address - Phone:631-897-3971
Mailing Address - Fax:
Practice Address - Street 1:6080 JERICHO TPKE STE 200
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2808
Practice Address - Country:US
Practice Address - Phone:631-864-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty