Provider Demographics
NPI:1295149581
Name:GRUSZCZYK, ALEXSANDRA
Entity type:Individual
Prefix:
First Name:ALEXSANDRA
Middle Name:
Last Name:GRUSZCZYK
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 1:1650 W MAIN ST STE 1
Mailing Address - Street 2:08371600
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-2842
Mailing Address - Country:US
Mailing Address - Phone:352-630-4133
Mailing Address - Fax:
Practice Address - Street 1:1650 W MAIN ST STE 1
Practice Address - Street 2:08371600
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-2842
Practice Address - Country:US
Practice Address - Phone:352-630-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst