=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033786975
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDRA NELDA MOREIRA COOLEY MA, BCABA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2021
-----------------------------------------------------
Last Update Date | 05/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3440 US HIGHWAY 1 S STE 202
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32086-6363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-823-4283
-----------------------------------------------------
Fax | 352-332-8589
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 WILDWOOD LN
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32137-3221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-227-6485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106E00000X
-----------------------------------------------------
Taxonomy Name | Assistant Behavior Analyst
-----------------------------------------------------
License Number | 0-25-15982
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------