Provider Demographics
NPI:1376289330
Name:COLIANDRIS, ALEXIS YIANNA (MED BCBA LABA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:YIANNA
Last Name:COLIANDRIS
Suffix:
Gender:F
Credentials:MED BCBA LABA
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:YIANNA
Other - Last Name:COLIANDRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:155 MAIN DUNSTABLE RD, SUITE 150
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3640
Mailing Address - Country:US
Mailing Address - Phone:184-490-2422
Mailing Address - Fax:
Practice Address - Street 1:80 PALOMINO LN STE 201
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6447
Practice Address - Country:US
Practice Address - Phone:184-490-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NH1-22-59123103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst