Basic Information
| Provider Information | |||||||||
| NPI: | 1346697000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORNING | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | FILIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1251 N. EDDY STREET | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466171478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5743079147 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1251 N. EDDY STREET | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465306258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5743079147 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2016 | ||||||||
| LastUpdateDate: | 02/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 20041625A | IN | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC1900X | 20041625A | IN | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.