1609469592 NPI number — ALEXIS JORDAN PASCARELLA M.A., BCBA, LBA

Table of content: ALEXIS JORDAN PASCARELLA M.A., BCBA, LBA (NPI 1609469592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609469592 NPI number — ALEXIS JORDAN PASCARELLA M.A., BCBA, LBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASCARELLA
Provider First Name:
ALEXIS
Provider Middle Name:
JORDAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., BCBA, LBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MELE
Provider Other First Name:
ALEXIS
Provider Other Middle Name:
JORDAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609469592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 S GILBERT RD APT 3043
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85296-0452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-715-6848
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5570 W CHANDLER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85226-3697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-608-5120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-20-46673 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com