Provider Demographics
NPI:1316598428
Name:SHUBERT, STEPHEN (MED, LBA, BCBA,)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:SHUBERT
Suffix:
Gender:M
Credentials:MED, LBA, BCBA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 N 1ST DR UNIT 347B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1462
Mailing Address - Country:US
Mailing Address - Phone:845-325-6775
Mailing Address - Fax:
Practice Address - Street 1:4848 E CACTUS RD STE 940
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4164
Practice Address - Country:US
Practice Address - Phone:480-433-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000482103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty