Provider Demographics
NPI:1487307526
Name:TRICKEY, ALEXANDRA N (CTRS)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:N
Last Name:TRICKEY
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:N
Other - Last Name:DOLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CTRS
Mailing Address - Street 1:15 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5445
Mailing Address - Country:US
Mailing Address - Phone:518-353-3334
Mailing Address - Fax:
Practice Address - Street 1:400 DOANSBURG RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-5902
Practice Address - Country:US
Practice Address - Phone:845-279-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33Medicaid