Provider Demographics
NPI:1285362038
Name:SCOTT, ALEXANDRA H (LICSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:H
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 56TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35212-4122
Mailing Address - Country:US
Mailing Address - Phone:225-333-2393
Mailing Address - Fax:
Practice Address - Street 1:2817 30TH AVE N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35207-4541
Practice Address - Country:US
Practice Address - Phone:205-407-5600
Practice Address - Fax:205-224-4171
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5237C1041C0700X
AL4753G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL299009Medicaid