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NPI Code Detail

MEDICARE: STACIA D BROCK M.S., BCBA, LBA

MEDICARE: STACIA D BROCK M.S., BCBA, LBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst2139TN

General Provider Information

NPI Number : 1003762238
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACIA D BROCK M.S., BCBA, LBA
Provider Business Mailing Address
First Line : PO BOX 360595
Second Line :
City : PITTSBURGH
State : PA
Zip : 15251-6595
Country : US
Telephone Number : 718-215-5311
Fax Number : 718-865-5165
Provider Business Practice Location Address
First Line : 268 VETERANS PKWY
Second Line :
City : MURFREESBORO
State : TN
Zip : 37128-6431
Country : US
Telephone Number : 718-251-5311
Fax Number : 718-865-5165
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2026
Last Update Date : 03/09/2026

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