MEDICARE: STEPHANIE MARIE DE LUISE

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	8990	TX

General Provider Information

NPI Number	:	1356221204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARIE DE LUISE

Provider Business Mailing Address
First Line	:	5715 ROCKY BROOK DR
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77345-1417
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5715 ROCKY BROOK DR
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77345-1417
Country	:	US
Telephone Number	:	832-302-1904
Fax Number	:

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

Provider Enumeration Date	:	09/03/2025
Last Update Date	:	09/03/2025

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Directions to “ STEPHANIE MARIE DE LUISE ” Practice Location

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