Provider Demographics
NPI:1306204722
Name:BROOKS, ALYSSA (BCBA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BROOKS
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 1:3062 BLUEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8704
Mailing Address - Country:US
Mailing Address - Phone:321-439-0688
Mailing Address - Fax:
Practice Address - Street 1:8617 E COLONIAL DR STE 1100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3919
Practice Address - Country:US
Practice Address - Phone:407-895-0801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-30
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-17-28318103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst