Provider Demographics
NPI:1366605958
Name:BURG, ALEXANDRA FAITH (MSSA, LISW-S, BCD)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:FAITH
Last Name:BURG
Suffix:
Gender:F
Credentials:MSSA, LISW-S, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 NOVICKY COURT
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4051
Mailing Address - Country:US
Mailing Address - Phone:216-584-9224
Mailing Address - Fax:
Practice Address - Street 1:1554 NOVICKY COURT
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4051
Practice Address - Country:US
Practice Address - Phone:216-584-9224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00097981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical