Provider Demographics
NPI:1255154811
Name:TRAUB, ALEXANDRA F
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:F
Last Name:TRAUB
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 1:1262 N TOPANGA CANYON BLVD # F
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-4269
Mailing Address - Country:US
Mailing Address - Phone:646-234-0124
Mailing Address - Fax:
Practice Address - Street 1:1262 N TOPANGA CANYON BLVD # F
Practice Address - Street 2:
Practice Address - City:TOPANGA
Practice Address - State:CA
Practice Address - Zip Code:90290-4269
Practice Address - Country:US
Practice Address - Phone:646-234-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17716101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional