Basic Information
| Provider Information | |||||||||
| NPI: | 1215553169 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAVERAS | ||||||||
| FirstName: | ALEXA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 W 15TH ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100116701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129246320 | ||||||||
| FaxNumber: | 6463060513 | ||||||||
| Practice Location | |||||||||
| Address1: | 28 DEBEVOISE ST STE 5 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112064194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189634430 | ||||||||
| FaxNumber: | 6463982794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2020 | ||||||||
| LastUpdateDate: | 11/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | N | Behavioral Health & Social Service Providers | Social Worker | School | 104100000X | 111020 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.