Healthcare Provider Details

I. General information

NPI: 1285591941
Provider Name (Legal Business Name): STACY MARIE SANTANA-PEREZ LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 HIGH POINT BLVD
BETHLEHEM PA
18017-7820
US

IV. Provider business mailing address

1023 E GORDON ST
ALLENTOWN PA
18109-2207
US

V. Phone/Fax

Practice location:
  • Phone: 610-867-3173
  • Fax:
Mailing address:
  • Phone: 610-867-3173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH008192
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: