Provider Demographics
NPI:1710525076
Name:GRZYWNA, ALEXANDRA LYNN (MSED, LMHC-P)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:LYNN
Last Name:GRZYWNA
Suffix:
Gender:F
Credentials:MSED, LMHC-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2904
Mailing Address - Country:US
Mailing Address - Phone:716-207-0278
Mailing Address - Fax:
Practice Address - Street 1:20 RICH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-3020
Practice Address - Country:US
Practice Address - Phone:716-895-7715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-P117114-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health