Individual
ALEXANDRIA LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
205 E 95TH ST APT 32E, NEW YORK, NY 10128-4075
(917) 454-4656
Mailing address
205 E 95TH ST APT 32E, NEW YORK, NY 10128-4075
(917) 454-4656
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
011425-01
NY
Other
Enumeration date
06/21/2021
Last updated
06/21/2021
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