Provider Demographics
NPI:1366947590
Name:GREBE, STACEY CLAIRE (PHD, LP, BCBA, NCSP)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:CLAIRE
Last Name:GREBE
Suffix:
Gender:F
Credentials:PHD, LP, BCBA, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 ALICEANNA ST FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4387
Mailing Address - Country:US
Mailing Address - Phone:713-319-7210
Mailing Address - Fax:
Practice Address - Street 1:720 ALICEANNA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4387
Practice Address - Country:US
Practice Address - Phone:443-923-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-18-29448103K00000X
TX1406103K00000X
MD390200000X
MD07029103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program