Provider Demographics
NPI:1215281191
Name:DE BRAGANCA, ALEXIS MAE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:MAE
Last Name:DE BRAGANCA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ALEXIS
Other - Middle Name:MAE
Other - Last Name:KRATKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:16 EAST 16TH STREET
Mailing Address - Street 2:INSTITUTE FOR FAMILY HEALTH MANHATTAN OFFICE
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-633-0800
Mailing Address - Fax:
Practice Address - Street 1:16 E 16TH STREET
Practice Address - Street 2:INSTITUTE FOR FAMILY HEALTH MANHATTAN OFFICE
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-633-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0784881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical