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NPI Code Detail

MEDICARE: STEPHANIE WHITAKER BCBA

MEDICARE: STEPHANIE WHITAKER BCBA
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
1390200000XStudent in an Organized Health Care Education/Training ProgramFL
2103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265771257
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE WHITAKER BCBA
Provider Business Mailing Address
First Line : 9160 BOURBON ST APT K
Second Line :
City : LAUREL
State : MD
Zip : 20723-1644
Country : US
Telephone Number : 954-554-4609
Fax Number :
Provider Business Practice Location Address
First Line : 6820 SOUTHPOINT PKWY STE 9
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-6277
Country : US
Telephone Number : 888-754-0398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2013
Last Update Date : 04/15/2021

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Directions to “ STEPHANIE WHITAKER BCBA” Practice Location

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