Provider Demographics
NPI:1245064112
Name:MARON, ALEXIS ASHLEY (RDT, BCT)
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:ASHLEY
Last Name:MARON
Suffix:
Gender:F
Credentials:RDT, BCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 PALM DR
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-5115
Mailing Address - Country:US
Mailing Address - Phone:310-422-9386
Mailing Address - Fax:
Practice Address - Street 1:137 PALM DR
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-5115
Practice Address - Country:US
Practice Address - Phone:310-422-9386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist