Provider Demographics
NPI:1780137919
Name:DEMOPOULOS, ALESSANDRA FEOLA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:ALESSANDRA
Middle Name:FEOLA
Last Name:DEMOPOULOS
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 1:2616 SW UNION TER
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2982
Mailing Address - Country:US
Mailing Address - Phone:772-215-8679
Mailing Address - Fax:
Practice Address - Street 1:2616 SW UNION TER
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2982
Practice Address - Country:US
Practice Address - Phone:772-215-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-23
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD514006886640247200000X
FLBACB335660103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other