Provider Demographics
NPI:1518253665
Name:BRACKETT, STEFFANIE R (PSYD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:STEFFANIE
Middle Name:R
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-4872
Mailing Address - Country:US
Mailing Address - Phone:781-572-5564
Mailing Address - Fax:
Practice Address - Street 1:236 GANETT DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6913
Practice Address - Country:US
Practice Address - Phone:207-661-3600
Practice Address - Fax:207-761-0783
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-05-2296103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst