1003220146 NPI number — MRS. STACEY LYNN GALIETTI MA, BCBA, LBA

Table of content: MRS. STACEY LYNN GALIETTI MA, BCBA, LBA (NPI 1003220146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003220146 NPI number — MRS. STACEY LYNN GALIETTI MA, BCBA, LBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALIETTI
Provider First Name:
STACEY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, BCBA, LBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PALLIS
Provider Other First Name:
STACEY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, BCBA, LBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003220146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28241 MOUND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48092-5523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-401-2244
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 W BIG BEAVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48084-3545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-464-0175
Provider Business Practice Location Address Fax Number:
586-464-0178
Provider Enumeration Date:
06/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 247200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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