Provider Demographics
NPI:1376652362
Name:BURGIN, STEPHANIE ELYSE (MS, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ELYSE
Last Name:BURGIN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13815 DEVAN LEE DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-5868
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13815 DEVAN LEE DR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-5868
Practice Address - Country:US
Practice Address - Phone:904-383-9761
Practice Address - Fax:904-696-9868
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst