Provider Demographics
NPI:1609322015
Name:MOCHAN, ALEXA R (M ED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:R
Last Name:MOCHAN
Suffix:
Gender:F
Credentials:M ED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 OLD EMMITSBURG RD
Mailing Address - Street 2:
Mailing Address - City:EMMITSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21727-7702
Mailing Address - Country:US
Mailing Address - Phone:301-447-5090
Mailing Address - Fax:
Practice Address - Street 1:343 S SETON AVE
Practice Address - Street 2:
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727-9226
Practice Address - Country:US
Practice Address - Phone:301-447-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-27
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-31907103K00000X
OH103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid