MEDICARE: MRS. STEPHANIE M PADILLA MA, BCBA

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
1	103K00000X	Behavior Analyst	1-21-54750	NM
2	106S00000X	Behavior Technician		NM

General Provider Information

NPI Number	:	1730675042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE M PADILLA MA, BCBA

Provider Business Mailing Address
First Line	:	8300 JEFFERSON ST NE STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1734
Country	:	US
Telephone Number	:	916-761-5205
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 JEFFERSON ST NE STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1734
Country	:	US
Telephone Number	:	916-761-5205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2018
Last Update Date	:	11/29/2022

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