Healthcare Provider Details

I. General information

NPI: 1275315335
Provider Name (Legal Business Name): ALEXIS RENEE KISSANE MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 TAVISTOCK LAKES BLVD STE 400
ORLANDO FL
32827-7593
US

IV. Provider business mailing address

2268 LITCHFIELD LOOP
DELAND FL
32720-3387
US

V. Phone/Fax

Practice location:
  • Phone: 800-875-1871
  • Fax: 800-875-1871
Mailing address:
  • Phone: 260-431-1525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89515
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-16255
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-148899
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: