Provider Demographics
NPI:1194049700
Name:ALEXANDRA A. LONC, PA
Entity type:Organization
Organization Name:ALEXANDRA A. LONC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LONC
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-540-6335
Mailing Address - Street 1:2151 W HILLSBORO BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1275
Mailing Address - Country:US
Mailing Address - Phone:954-540-6335
Mailing Address - Fax:954-429-8338
Practice Address - Street 1:2151 W HILLSBORO BLVD STE 211
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1275
Practice Address - Country:US
Practice Address - Phone:954-540-6335
Practice Address - Fax:954-429-8338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRYSTAL HEART COUNSELING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-25
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW71261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty