Provider Demographics
NPI:1306465638
Name:LECOURIEUX, ALICIA M (MS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:M
Last Name:LECOURIEUX
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:M
Other - Last Name:LA BRUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:58 WOODSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506
Mailing Address - Country:US
Mailing Address - Phone:201-538-0682
Mailing Address - Fax:
Practice Address - Street 1:1 FOREST COURT
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950
Practice Address - Country:US
Practice Address - Phone:973-722-9693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-18-33184103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst