Provider Demographics
NPI:1487786216
Name:SCARLETT, ALEXANDRA STORY (LICENSED PSYCHOLOGIS)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:STORY
Last Name:SCARLETT
Suffix:
Gender:F
Credentials:LICENSED PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:SAXTONS RIVER
Mailing Address - State:VT
Mailing Address - Zip Code:05154-0011
Mailing Address - Country:US
Mailing Address - Phone:802-869-2747
Mailing Address - Fax:
Practice Address - Street 1:3 ACADEMY AVENUE
Practice Address - Street 2:
Practice Address - City:SAXTONS RIVER
Practice Address - State:VT
Practice Address - Zip Code:05154
Practice Address - Country:US
Practice Address - Phone:802-869-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0470000678103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008207Medicaid