Healthcare Provider Details

I. General information

NPI: 1457287054
Provider Name (Legal Business Name): STEPHANIE NICOLE TAYLOR BCBA, LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 PENN AVE
SCRANTON PA
18503-1246
US

IV. Provider business mailing address

802 GINO MERLI DR
PECKVILLE PA
18452-1704
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-4665
  • Fax:
Mailing address:
  • Phone: 570-499-1180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-70516
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: