1285906438 NPI number — STACEY MONIQUE DELAROSA M.ED., BCBA, LBA

Table of content: STACEY MONIQUE DELAROSA M.ED., BCBA, LBA (NPI 1285906438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285906438 NPI number — STACEY MONIQUE DELAROSA M.ED., BCBA, LBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELAROSA
Provider First Name:
STACEY
Provider Middle Name:
MONIQUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., 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:
RAMIREZ
Provider Other First Name:
STACEY
Provider Other Middle Name:
MONIQUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285906438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 CENTRAL EXPY S STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75013-8122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-772-8847
Provider Business Mailing Address Fax Number:
248-912-1566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 CENTRAL EXPY S STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75013-8122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-772-8847
Provider Business Practice Location Address Fax Number:
248-912-1566
Provider Enumeration Date:
02/03/2012

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: 103K00000X , with the licence number:  11829680 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 149984001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207164901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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