Provider Demographics
NPI:1417611021
Name:AMY, ALEXIS ESPERANZA (QASP-S)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:ESPERANZA
Last Name:AMY
Suffix:
Gender:F
Credentials:QASP-S
Other - Prefix:MRS
Other - First Name:ALEXIS
Other - Middle Name:ESPERANZA
Other - Last Name:AMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 E MIRACLE PKWY
Mailing Address - Street 2:UNIT 503
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 RICKEY AVE UNIT C
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2520
Practice Address - Country:US
Practice Address - Phone:850-376-5624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician