Provider Demographics
NPI:1104189554
Name:RATNER, STACEY B (MS LBA BCBA LABA)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:B
Last Name:RATNER
Suffix:
Gender:F
Credentials:MS LBA BCBA LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DUFFY AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3636
Mailing Address - Country:US
Mailing Address - Phone:516-578-7093
Mailing Address - Fax:
Practice Address - Street 1:100 DUFFY AVE STE 510
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3636
Practice Address - Country:US
Practice Address - Phone:516-578-7093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000267103K00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist