Provider Demographics
NPI:1427351857
Name:STEPHENSON, ANNETTE L (BCBA)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:L
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 HERBERTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1713
Mailing Address - Country:US
Mailing Address - Phone:732-836-3322
Mailing Address - Fax:732-840-0965
Practice Address - Street 1:325 HERBERTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1713
Practice Address - Country:US
Practice Address - Phone:732-836-3322
Practice Address - Fax:732-840-0965
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-07-3943103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst