Healthcare Provider Details

I. General information

NPI: 1366947590
Provider Name (Legal Business Name): STACEY CLAIRE GREBE PHD, LP, BCBA, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ALICEANNA ST
BALTIMORE MD
21202-4387
US

IV. Provider business mailing address

720 ALICEANNA ST FL 4
BALTIMORE MD
21202-4387
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-9200
  • Fax:
Mailing address:
  • Phone: 713-319-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number07029
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-29448
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1406
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: