Provider Demographics
NPI:1275254708
Name:WISER, ALEXANDRA (RBT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:WISER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:OVSIEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:251 BLACKWATER PL
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3433
Mailing Address - Country:US
Mailing Address - Phone:215-360-2977
Mailing Address - Fax:
Practice Address - Street 1:907 OUTER RD STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6601
Practice Address - Country:US
Practice Address - Phone:407-217-1401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-231649106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician