Provider Demographics
NPI:1295341725
Name:GINGRAS, ALEXANDRA E (BCBA)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:E
Last Name:GINGRAS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:E
Other - Last Name:KNOEPPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:721 W LUTZ LAKE FERN RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4207
Mailing Address - Country:US
Mailing Address - Phone:813-385-6136
Mailing Address - Fax:
Practice Address - Street 1:721 W LUTZ LAKE FERN RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4207
Practice Address - Country:US
Practice Address - Phone:813-385-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-22-13770106E00000X
FLRBT-20-133089106S00000X
FL1-22-63374103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician