Provider Demographics
NPI:1306438338
Name:GOBEN, ALEXANDRIA MARIE (LCAT, ATR-BC)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:MARIE
Last Name:GOBEN
Suffix:
Gender:F
Credentials:LCAT, ATR-BC
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:MARIE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCAT, ATR-BC
Mailing Address - Street 1:433 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2115
Mailing Address - Country:US
Mailing Address - Phone:315-521-7025
Mailing Address - Fax:
Practice Address - Street 1:590 PRE EMPTION RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1372
Practice Address - Country:US
Practice Address - Phone:315-209-4669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002067101Y00000X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor