DR. ALEXANDRA BROUSTOVETSKAIA PH.D.
NPI 1124516026
Psychologist - Counseling in Raleigh, NC

Active since April 25, 2018Opted out of Medicare · through Oct 2, 2026
8303 SIX FORKS RD STE 207, RALEIGH, NC 27615(919) 245-7791 Get Directions Write a Review

NPPES record last updated: October 2, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Oct 2, 2018, Apr 25, 2018 (2 updates tracked since 2018).

About Dr. Alexandra Broustovetskaia Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ALEXANDRA BROUSTOVETSKAIA PH.D. (NPI 1124516026) is an individual counseling provider in Raleigh, North Carolina, licensed in Massachusetts (10641) and active in the NPI registry since April 2018. She has opted out of Medicare through October 2, 2026 and remains eligible to order and refer and maintains a secondary practice location in Boston.

NPPES Registry Identity

NPI1124516026
Entity TypeIndividualFemale
Primary Taxonomy103TC1900X
Provider Legal NameDR. ALEXANDRA BROUSTOVETSKAIACredential: PH.D.
Location Address8303 SIX FORKS RD STE 207Raleigh, NC 27615
Mailing Address8303 Six Forks Rd Ste 207Raleigh, NC 27615-3094 · (919) 245-7791
Sole ProprietorNo
Enumeration DateApril 25, 2018
Last NPPES UpdateOctober 2, 20182 updates tracked since enumeration
NPI 1124516026 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologist · CounselingBehavioral Health & Social Service Providers
Taxonomy Code103TC1900X
License Licensed in MA · 10641
Definition
A psychologist who specializes in general practice and health service. It focuses on how people function both personally and in their relationships at all ages. Counseling psychology addresses the emotional, social, work, school and physical health concerns people may have at different stages in their lives, focusing on typical life stresses and more severe issues with which people may struggle as individuals and as a part of families, groups and organizations. Counseling psychologists help people with physical, emotional and mental health issues improve their sense of well-being, alleviate feelings of distress and resolve crises. They also provide assessment, diagnosis, and treatment of more severe psychological symptoms.
8303 SIX FORKS RD STE 207, Raleigh, NC 27615

Secondary Practice Location 1

Location 1400 FenwayBoston, MA 02115-5725 · Phone (617) 735-9920

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Dr. Alexandra Broustovetskaia Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 2, 2018 through October 2, 2026.

Opt-Out Effective DateOctober 2, 2018
Opt-Out In Effect ThroughOctober 2, 2026Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Psychologist (Clinical)
8303 SIX FORKS RD STE 207
RALEIGH, NC 27615
Psychologist (Clinical)
8303 SIX FORKS RD STE 207
RALEIGH, NC 27615
Psychologist (Clinical)
8303 SIX FORKS RD STE 207
RALEIGH, NC 27615
Psychologist
8303 SIX FORKS RD STE 207
RALEIGH, NC 27615
Psychologist (Clinical)
8303 SIX FORKS RD STE 207
RALEIGH, NC 27615
Psychologist
8303 SIX FORKS RD STE 207
RALEIGH, NC 27615

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Alexandra Broustovetskaia's NPI number?

The NPI number for Alexandra Broustovetskaia is 1124516026. It was assigned to this individual provider in the NPPES registry on April 25, 2018.

Where is Alexandra Broustovetskaia located?

Alexandra Broustovetskaia practices at 8303 Six Forks Rd Ste 207, Raleigh, NC 27615. The listed phone number is (919) 245-7791.

What is Alexandra Broustovetskaia's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Counseling, with taxonomy code 103TC1900X.

Is Alexandra Broustovetskaia enrolled in Medicare?

No. Alexandra Broustovetskaia has opted out of Medicare through October 2, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Alexandra Broustovetskaia was last updated on October 2, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.