Provider Demographics
NPI:1033746219
Name:FINE, ALEXANDRA (BCBA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:FINE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6303
Mailing Address - Country:US
Mailing Address - Phone:516-974-1356
Mailing Address - Fax:
Practice Address - Street 1:5 ANDOVER DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-6303
Practice Address - Country:US
Practice Address - Phone:516-974-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-37855103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst