Provider Demographics
NPI:1750082103
Name:IVY, ALEXANDRA (MHC-LP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:IVY
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1621
Mailing Address - Country:US
Mailing Address - Phone:518-527-5491
Mailing Address - Fax:
Practice Address - Street 1:461 MILLER RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1621
Practice Address - Country:US
Practice Address - Phone:518-527-5491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP120496101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health