Healthcare Provider Details

I. General information

NPI: 1255110862
Provider Name (Legal Business Name): STEPHANIE VICARIO BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46040 CENTER OAK PLZ STE 115
STERLING VA
20166-6611
US

IV. Provider business mailing address

46040 CENTER OAK PLZ STE 115
STERLING VA
20166-6611
US

V. Phone/Fax

Practice location:
  • Phone: 703-496-7804
  • Fax:
Mailing address:
  • Phone: 929-720-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133003237
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: