Provider Demographics
NPI:1437992088
Name:STARK, ALEXANDER MICHAEL (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:MICHAEL
Last Name:STARK
Suffix:
Gender:M
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 WEST AVE APT MB208
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-4054
Mailing Address - Country:US
Mailing Address - Phone:203-586-8418
Mailing Address - Fax:
Practice Address - Street 1:59 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4405
Practice Address - Country:US
Practice Address - Phone:203-210-7124
Practice Address - Fax:203-210-7126
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1907103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst