MEDICARE: ALEXANDRA ELIZABETH PERL

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	:	1144874850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA ELIZABETH PERL

Provider Business Mailing Address
First Line	:	2928 QUEENSLAND DR
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-5244
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9201 ARBORETUM PKWY # 160
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-5402
Country	:	US
Telephone Number	:	413-424-4794
Fax Number	:

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

Provider Enumeration Date	:	07/31/2019
Last Update Date	:	07/31/2019

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