MEDICARE: ALEXA JEAN TIVEY

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	1-25-85600	MA

General Provider Information

NPI Number	:	1689341752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA JEAN TIVEY

Provider Business Mailing Address
First Line	:	171 BEECH ST APT 2
Second Line	:
City	:	BELMONT
State	:	MA
Zip	:	02478-1858
Country	:	US
Telephone Number	:	978-726-7487
Fax Number	:

Provider Business Practice Location Address
First Line	:	491 DUTTON ST UNIT 417
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01854-4291
Country	:	US
Telephone Number	:	978-726-7487
Fax Number	:

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

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	06/15/2026

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