Provider Demographics
NPI:1235951591
Name:FAVRET, ALEXANDRA MONET
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MONET
Last Name:FAVRET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 DEERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-7317
Mailing Address - Country:US
Mailing Address - Phone:203-903-4569
Mailing Address - Fax:
Practice Address - Street 1:58 WELLINGTON RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-1641
Practice Address - Country:US
Practice Address - Phone:203-903-4569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8375104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker