Provider Demographics
NPI:1932821410
Name:JOHNSON, ALEXANDRA TERESIA (MA, BCABA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:TERESIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26349 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1140
Mailing Address - Country:US
Mailing Address - Phone:631-603-5553
Mailing Address - Fax:
Practice Address - Street 1:26349 74TH AVE
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1140
Practice Address - Country:US
Practice Address - Phone:631-603-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty