NPIMap

Individual provider Active NPI

Alexandra Rene Daniels, MA, BCBA, LBA, COBA

  • Behavior Analyst
  • Southgate, KY
National Provider Identifier
1992152565
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
167338 Issued in KY
Practice address
127 Harvard PL.
Southgate, KY 41071
Phone
(859) 443-6622
NPI assigned
May 24, 2016
Last updated
Jan 31, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 256 OH
Behavior Analyst 103K00000X COBA.256 OH
Behavior Analyst 103K00000X 167338 KY Primary

Addresses

Primary practice location

127 Harvard PL.
Southgate, KY 41071

Mailing address

127 Harvard PL.
Southgate, KY 41071
Phone (859) 443-6622

Other identifiers 1

IdentifierTypeStateIssuer
1-16-21799OtherBEHAVIOR ANALYST CERT

Other names 1

  • Alexandra Rene Fawcett Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
167338KYMDBehavioral Analyst
256OHMDBehavioral Analyst
COBA.256OHMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric ABA and Autism Supports of Northern Kentucky LLC Behavior Analyst Current Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1992152565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 HARVARD PL.",
            "city": "SOUTHGATE",
            "state": "KY",
            "postal_code": "41071",
            "telephone_number": "859-443-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 HARVARD PL.",
            "city": "SOUTHGATE",
            "state": "KY",
            "postal_code": "41071",
            "telephone_number": "859-443-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANIELS",
        "first_name": "ALEXANDRA",
        "middle_name": "RENE",
        "name_prefix": "Mrs.",
        "credential": "MA, BCBA, LBA, COBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-24",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "OH",
            "license": "256",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "OH",
            "license": "COBA.256",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "KY",
            "license": "167338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEHAVIOR ANALYST CERT",
            "identifier": "1-16-21799",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALEXANDRA",
            "last_name": "FAWCETT",
            "middle_name": "RENE",
            "credential": "MA, BCBA, LBA, COBA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Southgate, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.