Provider Demographics
NPI:1316273055
Name:LAKE, ALEXIS (MSS, LSW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:LAKE
Suffix:
Gender:F
Credentials:MSS, LSW
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:LAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:931 HARRISBURG AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2652
Mailing Address - Country:US
Mailing Address - Phone:717-544-9051
Mailing Address - Fax:717-735-9234
Practice Address - Street 1:931 HARRISBURG AVE STE 9
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2652
Practice Address - Country:US
Practice Address - Phone:717-544-9051
Practice Address - Fax:717-735-9234
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-01
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1272411041C0700X
PACW0198251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical