Individual
STEPHANIE JEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8762 TOWN AND COUNTRY BLVD, ELLICOTT CITY, MD 21043
(301) 825-6265
Mailing address
1314 GLYNDON AVE, BALTIMORE, MD 21223-3613
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-36416
—
106S00000X
Behavior Technician
BACB342927
MD
Other
Enumeration date
01/20/2017
Last updated
09/17/2020
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