Healthcare Provider Details

I. General information

NPI: 1639761166
Provider Name (Legal Business Name): MANUEL ALEJANDRO CANO BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 CLEMMONS RD
CLEMMONS NC
27012-8479
US

IV. Provider business mailing address

3950 CLEMMONS RD
CLEMMONS NC
27012-8479
US

V. Phone/Fax

Practice location:
  • Phone: 252-751-0518
  • Fax:
Mailing address:
  • Phone: 252-751-0518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB565854
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: