Provider Information for 1811567290
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Mr. ALEXANDER JACOB MABIE MSW
Sex: Male
NPI: 1811567290
Last Updated: 2024-08-11
Certification Date: 2024-08-11
Certification Date: 2024-08-11
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1811567290 | ||||||||||||
| Enumeration Date | 2021-06-29 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 819 114TH AVE N APT 906 ST PETERSBURG, FL 33716-2604 United States Phone: 813-514-7851 | Fax: | ||||||||||||
| Primary Practice Address | 3840 5TH AVE N ST PETERSBURG, FL 33713-7521 United States Phone: 727-367-2273 | Fax: | ||||||||||||
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