Provider Demographics
NPI:1194531574
Name:ALEXA, KRISTOFER ALEXANDER
Entity type:Individual
Prefix:
First Name:KRISTOFER
Middle Name:ALEXANDER
Last Name:ALEXA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 NORTHEASTERN BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3161
Mailing Address - Country:US
Mailing Address - Phone:603-882-3616
Mailing Address - Fax:
Practice Address - Street 1:45 HIGH ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3312
Practice Address - Country:US
Practice Address - Phone:603-821-7788
Practice Address - Fax:603-821-5620
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC10002624101YM0800X
MA10002624101YM0800X
NH4938101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health