Healthcare Provider Details

I. General information

NPI: 1861930372
Provider Name (Legal Business Name): ALEXIS VANCE BCBA, LBA-AL, LBA-NY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 WEKIVA SPRINGS RD STE 3000
LONGWOOD FL
32779-5949
US

IV. Provider business mailing address

4620 N STATE ROAD 7 STE 300
LAUDERDALE LAKES FL
33319-5867
US

V. Phone/Fax

Practice location:
  • Phone: 352-727-8439
  • Fax:
Mailing address:
  • Phone: 352-727-8439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number003188-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: