Healthcare Provider Details

I. General information

NPI: 1083482285
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL STABILE EDD BCBA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 SE PORT ST LUCIE BLVD
PORT SAINT LUCIE FL
34952-5530
US

IV. Provider business mailing address

2412 SW WAIKIKI ST
PORT SAINT LUCIE FL
34953-2569
US

V. Phone/Fax

Practice location:
  • Phone: 772-463-0444
  • Fax: 772-219-1339
Mailing address:
  • Phone: 954-243-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: