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NPI Code Detail

MEDICARE: STEPHEN IRVING BCBA, LBA

MEDICARE:   STEPHEN  IRVING  BCBA, LBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2103K00000XBehavior AnalystLBA1721MD

General Provider Information

NPI Number : 1306450622
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN IRVING BCBA, LBA
Provider Business Mailing Address
First Line : 2288 BLUE WATER BLVD
Second Line :
City : ODENTON
State : MD
Zip : 21113-3309
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 500 REDLAND CT STE 102
Second Line :
City : OWINGS MILLS
State : MD
Zip : 21117-3265
Country : US
Telephone Number : 443-738-5110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2020
Last Update Date : 02/02/2024

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Directions to “ STEPHEN IRVING BCBA, LBA” Practice Location

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