Provider Demographics
NPI:1518256841
Name:WEIS, ALEXANDRA GRAY (BA, BCABA)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:GRAY
Last Name:WEIS
Suffix:
Gender:F
Credentials:BA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 NW 54TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-2005
Mailing Address - Country:US
Mailing Address - Phone:352-371-8172
Mailing Address - Fax:
Practice Address - Street 1:2525 NW 54TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-2005
Practice Address - Country:US
Practice Address - Phone:352-371-8172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-02-0608103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst