Provider Demographics
NPI:1417672056
Name:TUCKER, STEPHANIE TWEED (BCBA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TWEED
Last Name:TUCKER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:TWEED
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 VILLAGE SQ STE 210
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1624
Mailing Address - Country:US
Mailing Address - Phone:866-565-7222
Mailing Address - Fax:877-734-1914
Practice Address - Street 1:46040 CENTER OAK PLZ STE 150
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6611
Practice Address - Country:US
Practice Address - Phone:866-565-7222
Practice Address - Fax:877-934-1914
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1-21-54185103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst