Provider Demographics
NPI:1902264187
Name:ROBERSON, ALEKSANDRA IVANOVSKA I (BCABA)
Entity Type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:IVANOVSKA
Last Name:ROBERSON
Suffix:I
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-6119
Mailing Address - Country:US
Mailing Address - Phone:207-206-6723
Mailing Address - Fax:
Practice Address - Street 1:110 MARGINAL WAY #289
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-408-2701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0-14-6094103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst