MEDICARE: STEPHANIE VASS 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	1-23-65930	PA

General Provider Information

NPI Number	:	1194693887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE VASS BCBA, LBA

Provider Business Mailing Address
First Line	:	1302 S DIVINITY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-5127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 S DIVINITY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-5127
Country	:	US
Telephone Number	:	610-295-7027
Fax Number	:

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

Provider Enumeration Date	:	10/25/2025
Last Update Date	:	10/25/2025

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