Provider Demographics
NPI:1194011031
Name:LABAK, STACEE MARIE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:STACEE
Middle Name:MARIE
Last Name:LABAK
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:STACEE
Other - Middle Name:MARIE
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:15 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2205
Mailing Address - Country:US
Mailing Address - Phone:508-298-1638
Mailing Address - Fax:508-298-6024
Practice Address - Street 1:15 SOUTH ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2205
Practice Address - Country:US
Practice Address - Phone:508-298-1638
Practice Address - Fax:508-298-6024
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11415744103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst