Provider Demographics
NPI:1215654918
Name:SCHAFER, ALEXIS CRESCENCE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:CRESCENCE
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ONTARIO STREET
Mailing Address - Street 2:
Mailing Address - City:LOCKPOT
Mailing Address - State:NY
Mailing Address - Zip Code:14094
Mailing Address - Country:US
Mailing Address - Phone:716-433-1937
Mailing Address - Fax:716-433-1961
Practice Address - Street 1:33 ONTARIO STREET
Practice Address - Street 2:
Practice Address - City:LOCKPOT
Practice Address - State:NY
Practice Address - Zip Code:14094
Practice Address - Country:US
Practice Address - Phone:716-433-1937
Practice Address - Fax:716-433-1961
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP117570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health