Healthcare Provider Details

I. General information

NPI: 1508517699
Provider Name (Legal Business Name): AZEB GEBRE PH.D., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 SILVERSIDE RD STE 105
WILMINGTON DE
19810-4902
US

IV. Provider business mailing address

3511 SILVERSIDE RD STE 105
WILMINGTON DE
19810-4902
US

V. Phone/Fax

Practice location:
  • Phone: 302-455-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-56255
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: