MEDICARE: ALEXANDER JOSEPH BORISH BCBA

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
2	103K00000X	Behavior Analyst	1-24-75661	CA

General Provider Information

NPI Number	:	1669972857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER JOSEPH BORISH BCBA

Provider Business Mailing Address
First Line	:	5834 ADENMOOR AVE
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-1002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5834 ADENMOOR AVE
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-1002
Country	:	US
Telephone Number	:	303-989-8169
Fax Number	:

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

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	09/16/2024

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