Individual
ALEVTINA BASANTSOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
450 N PARK RD STE 400, HOLLYWOOD, FL 33021-6918
(954) 925-3191
Mailing address
133 NE 2ND AVE APT 3106, MIAMI, FL 33132-2920
(561) 543-0441
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-23-64699
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-23-64699
BOARD CERTIFIED BEHAVIOR ANALYST
FL
Enumeration date
08/23/2020
Last updated
11/24/2023
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