Provider Demographics
NPI:1013207174
Name:STINE, JAIME (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:
Last Name:STINE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:MISS
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:SCHILLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:21 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1231
Mailing Address - Country:US
Mailing Address - Phone:201-417-3873
Mailing Address - Fax:
Practice Address - Street 1:21 PARK AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1231
Practice Address - Country:US
Practice Address - Phone:201-417-3873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-10-6797103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst