Basic Information
| Provider Information | |||||||||
| NPI: | 1063745966 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GORMAN | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | MARRIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 7TH ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926611145 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1504 BROOKHOLLOW DR | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927055418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149571004 | ||||||||
| FaxNumber: | 7149571065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2009 | ||||||||
| LastUpdateDate: | 09/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.