Provider Demographics
NPI:1265321814
Name:PRODROMAKIS, ALEXA TERESA
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:TERESA
Last Name:PRODROMAKIS
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 1:35 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1460
Mailing Address - Country:US
Mailing Address - Phone:631-662-5200
Mailing Address - Fax:
Practice Address - Street 1:70 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-2416
Practice Address - Country:US
Practice Address - Phone:516-206-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP130502103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist