Provider Demographics
NPI:1023469343
Name:KOSMA, ALEXANDRA (BCBA)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:KOSMA
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 1:30 BUXTON FARM RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1224
Mailing Address - Country:US
Mailing Address - Phone:720-979-6330
Mailing Address - Fax:
Practice Address - Street 1:1080 MILL HILL TER
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890
Practice Address - Country:US
Practice Address - Phone:203-292-5837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-16-22519103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst