Provider Demographics
NPI:1285906438
Name:DELAROSA, STACEY MONIQUE (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MONIQUE
Last Name:DELAROSA
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:MONIQUE
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 CENTRAL EXPY S STE 230
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8122
Mailing Address - Country:US
Mailing Address - Phone:855-772-8847
Mailing Address - Fax:248-912-1566
Practice Address - Street 1:1301 CENTRAL EXPY S STE 230
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8122
Practice Address - Country:US
Practice Address - Phone:855-772-8847
Practice Address - Fax:248-912-1566
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11829680103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX207164901Medicaid
TX676535Medicare PIN
TX456606Medicare PIN