Provider Demographics
NPI:1043585672
Name:POLVERINO, ALEXA MARY (PHD)
Entity type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:MARY
Last Name:POLVERINO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9921 4TH AVE
Mailing Address - Street 2:UNIT 4A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8351
Mailing Address - Country:US
Mailing Address - Phone:917-613-2118
Mailing Address - Fax:
Practice Address - Street 1:800 POLY PL
Practice Address - Street 2:PSYCHOLOGY DEPARTMENT, 16TH FLOOR (116B)
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:718-836-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019528103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist