Provider Demographics
NPI:1578019592
Name:SIMON, ALEXIS B (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:B
Last Name:SIMON
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 DOUGLAS AVE STE 1855
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2588
Mailing Address - Country:US
Mailing Address - Phone:407-212-1199
Mailing Address - Fax:407-386-7037
Practice Address - Street 1:455 DOUGLAS AVE STE 1855
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2588
Practice Address - Country:US
Practice Address - Phone:407-212-1199
Practice Address - Fax:407-386-7037
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst