MEDICARE: STEPHANIE REMINGTON 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
1	103K00000X	Behavior Analyst	2017-067	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-12-12596	OTHER		BEHAVIOR ANALYST CERTIFICATION BOARD
2	12561964	OTHER		CAQH
3	2017-067	OTHER	AL	ALABAMA BEHAVIOR ANALYST LICENSURE BOARD

General Provider Information

NPI Number	:	1023452513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE REMINGTON BCBA, LBA

Provider Business Mailing Address
First Line	:	5451 ABLE CT
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36693-3100
Country	:	US
Telephone Number	:	251-410-0160
Fax Number	:	251-410-5968

Provider Business Practice Location Address
First Line	:	2233 CAHABA VALLEY DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-2602
Country	:	US
Telephone Number	:	205-994-4474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	04/01/2020

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