Provider Demographics
NPI:1073239513
Name:LYNCH, ALEXANDRA EDITH (BCBA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:EDITH
Last Name:LYNCH
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 1:180 BROAD ST APT 1119
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2076
Mailing Address - Country:US
Mailing Address - Phone:631-413-7771
Mailing Address - Fax:
Practice Address - Street 1:112 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4617
Practice Address - Country:US
Practice Address - Phone:203-286-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1531103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty