Healthcare Provider Details

I. General information

NPI: 1720721467
Provider Name (Legal Business Name): STACI MCGLADE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 W VETERANS HWY
JACKSON NJ
08527-3410
US

IV. Provider business mailing address

175 BELGROVE DR
KEARNY NJ
07032-1507
US

V. Phone/Fax

Practice location:
  • Phone: 201-979-1336
  • Fax: 908-940-0338
Mailing address:
  • Phone: 201-979-1336
  • Fax: 908-940-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00165100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-157952
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: