Basic Information
Provider Information
NPI: 1336272905
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALEXANDER
FirstName: DEBORAH
MiddleName: SUSAN
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 415 15TH ST
Address2:  
City: SANTA MONICA
State: CA
PostalCode: 904022231
CountryCode: US
TelephoneNumber: 3103931243
FaxNumber: 3103933013
Practice Location
Address1: 1533 EUCLID ST
Address2: FAMILY SERVICE OF SANTA MONICA
City: SANTA MONICA
State: CA
PostalCode: 904043306
CountryCode: US
TelephoneNumber: 3104519747
FaxNumber: 3104516156
Other Information
ProviderEnumerationDate: 03/13/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XLCS10641CAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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