Provider Demographics
NPI:1497231203
Name:VELENGER, STEPHANIE CHRISTA (BCBA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CHRISTA
Last Name:VELENGER
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 1:69 NEW COLONY DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1362
Mailing Address - Country:US
Mailing Address - Phone:609-540-1933
Mailing Address - Fax:
Practice Address - Street 1:231 HUTTON ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-4261
Practice Address - Country:US
Practice Address - Phone:201-743-8689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-15
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11417787103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst