Provider Demographics
NPI:1992290993
Name:GIRGUS, ALEXIS MARIE (BSW LSW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:GIRGUS
Suffix:
Gender:F
Credentials:BSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 STUTZ DR STE C
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9176
Mailing Address - Country:US
Mailing Address - Phone:330-565-8375
Mailing Address - Fax:
Practice Address - Street 1:3620 STUTZ DR STE C
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9176
Practice Address - Country:US
Practice Address - Phone:330-565-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$Medicaid