MEDICARE: ALEXIS VANCE MS, BCBA, NYS-LBA

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	103K00000X	Behavior Analyst	003188-01	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861930372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS VANCE MS, BCBA, NYS-LBA

Provider Business Mailing Address
First Line	:	1366 SAINT JOHNS PL APT 7
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-3818
Country	:	US
Telephone Number	:	352-727-8439
Fax Number	:

Provider Business Practice Location Address
First Line	:	1366 SAINT JOHNS PL APT 7
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-3818
Country	:	US
Telephone Number	:	352-727-8439
Fax Number	:

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

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	12/11/2023

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