MEDICARE: ALEC JOHN MARCHITELLO RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1053805853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEC JOHN MARCHITELLO RBT

Provider Business Mailing Address
First Line	:	1075 TABLE TOP TER
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-2264
Country	:	US
Telephone Number	:	720-217-9228
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 N ACADEMY BLVD STE 160
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3665
Country	:	US
Telephone Number	:	720-358-4634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	06/15/2018

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