Healthcare Provider Details

I. General information

NPI: 1306450622
Provider Name (Legal Business Name): STEPHEN IRVING BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 REDLAND CT STE 102
OWINGS MILLS MD
21117-3265
US

IV. Provider business mailing address

2288 BLUE WATER BLVD
ODENTON MD
21113-3309
US

V. Phone/Fax

Practice location:
  • Phone: 443-738-5110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA1721
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: