Provider Demographics
NPI:1356675847
Name:BLACK, ALICIA A (BCBA)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:A
Last Name:BLACK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
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Mailing Address - Street 1:657 SABAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-6186
Mailing Address - Country:US
Mailing Address - Phone:407-678-8889
Mailing Address - Fax:407-678-8885
Practice Address - Street 1:848 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7699
Practice Address - Country:US
Practice Address - Phone:407-678-8889
Practice Address - Fax:407-678-8885
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst