Individual
ALEXA KAREN PONCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9114 37TH AVE, JACKSON HEIGHTS, NY 11372-7920
(718) 779-1600
Mailing address
10436 42ND AVE, CORONA, NY 11368-2535
(917) 974-4553
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
084906
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
077199
NYS LICENSE #
NY
Enumeration date
11/14/2006
Last updated
12/19/2016
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