Provider Demographics
NPI:1538626353
Name:TAYLOR, ALEXANDRA (LCSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:D'EMIDIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:20623 ALBERMARLE LN
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-7563
Mailing Address - Country:US
Mailing Address - Phone:973-879-6305
Mailing Address - Fax:
Practice Address - Street 1:32060 LONG NECK RD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-6228
Practice Address - Country:US
Practice Address - Phone:302-645-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0001667101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEQ1-0001667OtherDELAWARE STATE LICENSE