Basic Information
| Provider Information | |||||||||
| NPI: | 1295149581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRUSZCZYK | ||||||||
| FirstName: | ALEXSANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 W MAIN ST STE 1 | ||||||||
| Address2: | 08371600 | ||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347482842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526304133 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1650 W MAIN ST STE 1 | ||||||||
| Address2: | 08371600 | ||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347482842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526304133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2014 | ||||||||
| LastUpdateDate: | 06/16/2014 | ||||||||
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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 | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.