Provider Demographics
NPI:1992152565
Name:DANIELS, ALEXANDRA RENE (MA, BCBA, LBA, COBA)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:RENE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MA, BCBA, LBA, COBA
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:RENE
Other - Last Name:FAWCETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA, LBA, COBA
Mailing Address - Street 1:127 HARVARD PL.
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:KY
Mailing Address - Zip Code:41071
Mailing Address - Country:US
Mailing Address - Phone:859-443-6622
Mailing Address - Fax:
Practice Address - Street 1:127 HARVARD PL.
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:KY
Practice Address - Zip Code:41071
Practice Address - Country:US
Practice Address - Phone:859-443-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH256103K00000X
OHCOBA.256103K00000X
KY167338103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-16-21799OtherBEHAVIOR ANALYST CERT