Provider Demographics
NPI:1104391895
Name:FLORA, STEPHEN RAY (BCBA-D)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RAY
Last Name:FLORA
Suffix:
Gender:M
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 OLD FURNACE RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-1338
Mailing Address - Country:US
Mailing Address - Phone:330-518-2109
Mailing Address - Fax:
Practice Address - Street 1:1036 OLD FURNACE RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-1338
Practice Address - Country:US
Practice Address - Phone:330-518-2109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.139103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty