Basic Information
| Provider Information | |||||||||
| NPI: | 1144972258 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEPE | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | DREW | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 53 SEMINARY RD | ||||||||
| Address2: | |||||||||
| City: | SIMSBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060702027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609652917 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 828 SULLIVAN AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060742093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605695900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2022 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 11983 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.