Provider Demographics
NPI:1447088000
Name:ANCKLE, ALESSANDROS ARIEL
Entity type:Individual
Prefix:MR
First Name:ALESSANDROS
Middle Name:ARIEL
Last Name:ANCKLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13971 SW 179TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7744
Mailing Address - Country:US
Mailing Address - Phone:786-327-0144
Mailing Address - Fax:
Practice Address - Street 1:13971 SW 179TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-7744
Practice Address - Country:US
Practice Address - Phone:786-327-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB794196106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician