Provider Demographics
NPI:1043878622
Name:LACROIX, ALEXANDRA (BCBA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:LACROIX
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 1:716 EAST ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3849
Mailing Address - Country:US
Mailing Address - Phone:203-525-6068
Mailing Address - Fax:
Practice Address - Street 1:716 EAST ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3849
Practice Address - Country:US
Practice Address - Phone:203-525-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT787103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst