Provider Demographics
NPI:1750770673
Name:MOTT, ALEXANDRA
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MOTT
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 1:6910 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9517
Mailing Address - Country:US
Mailing Address - Phone:716-352-9722
Mailing Address - Fax:
Practice Address - Street 1:6910 HAMILTON DR
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9517
Practice Address - Country:US
Practice Address - Phone:716-352-9722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11224101YP2500X
COLPC0018775101YP2500X
101Y00000X
AZ21591101YP2500X
UT13069748-6004101YP2500X
NJ37PC00971800101YP2500X
TX92599101YP2500X
NY008107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor