Healthcare Provider Details

I. General information

NPI: 1114302999
Provider Name (Legal Business Name): PARTNERSHIP FOR BEHAVIOR CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 MIAMI ST
SOUTH BEND IN
46614-1336
US

IV. Provider business mailing address

2314 MIAMI ST
SOUTH BEND IN
46614-1336
US

V. Phone/Fax

Practice location:
  • Phone: 574-329-6856
  • Fax: 888-675-2345
Mailing address:
  • Phone: 574-329-6856
  • Fax: 888-675-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: DR. SORAH STEIN
Title or Position: OWNER, CLINICAL DIRECTOR
Credential: PHD, BCBA-D
Phone: 574-329-6856