Provider Demographics
NPI:1699273565
Name:MACY, ALEXANDRA LIN (LCSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LIN
Last Name:MACY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CORLISS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834-1003
Mailing Address - Country:US
Mailing Address - Phone:518-260-4763
Mailing Address - Fax:
Practice Address - Street 1:145 PINE HAVEN SHORES RD STE 1000A
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7812
Practice Address - Country:US
Practice Address - Phone:775-553-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01319221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical