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General NPI Number Information
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NPI Number | 1376135640
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Entity Type | Individual
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Provider Name | MARC BILLY STEPHEN
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Gender | Male
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 1401 SE GOLDTREE DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7584
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Country | US
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Telephone | 772-212-7539
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Fax |
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Provider Business Mailing Address
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Address Line | 1665 SW JANETTE AVE
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-1116
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Country | US
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Telephone | 812-617-2567
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-26-87080
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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