Provider Demographics
NPI:1225526171
Name:STAMPER, LASANDRA (BCBA)
Entity Type:Individual
Prefix:
First Name:LASANDRA
Middle Name:
Last Name:STAMPER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 DELAWARE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:DE
Mailing Address - Zip Code:19938-3963
Mailing Address - Country:US
Mailing Address - Phone:609-721-2724
Mailing Address - Fax:
Practice Address - Street 1:389 DELAWARE RIVER DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:DE
Practice Address - Zip Code:19938-3963
Practice Address - Country:US
Practice Address - Phone:609-721-2724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1-19-39757103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst