Individual
ALEXA CUSTODIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
144 MAIN ST STE G, EAST HARTFORD, CT 06118-3239
(888) 754-0398
Mailing address
75 DAVIS AVE APT 1, VERNON, CT 06066-3181
(860) 804-5130
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/28/2023
Last updated
03/28/2023
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