Healthcare Provider Details

I. General information

NPI: 1386148922
Provider Name (Legal Business Name): ALEXANDRA MARIA NEWELL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 S DOBSON RD STE 200
MESA AZ
85202-6412
US

IV. Provider business mailing address

4632 E GERMANN RD APT 3036
GILBERT AZ
85297-2318
US

V. Phone/Fax

Practice location:
  • Phone: 508-455-7924
  • Fax:
Mailing address:
  • Phone: 508-455-7924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-37643
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: