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NPI Code Detail

MEDICARE: ALEXANDER FORTON BCABA

MEDICARE: ALEXANDER FORTON BCABA
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
1103K00000XBehavior Analyst0-17-8064FL
2247200000XOther Technician
3106E00000XAssistant Behavior Analyst0-17-8064FL

General Provider Information

NPI Number : 1205236130
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDER FORTON BCABA
Provider Business Mailing Address
First Line : 1855 W HIBISCUS BLVD
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-2622
Country : US
Telephone Number : 321-265-4409
Fax Number :
Provider Business Practice Location Address
First Line : 5163 ROSWELL RD
Second Line :
City : SANDY SPRINGS
State : GA
Zip : 30342-2206
Country : US
Telephone Number : 877-288-4760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2014
Last Update Date : 10/24/2019

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