Provider Demographics
NPI:1598124935
Name:STANLEY, ANNE (RBT INTERN)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:RBT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 KINGS MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-8555
Mailing Address - Country:US
Mailing Address - Phone:505-577-3884
Mailing Address - Fax:
Practice Address - Street 1:4096 PIEDMONT AVE
Practice Address - Street 2:#161
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5221
Practice Address - Country:US
Practice Address - Phone:866-273-2451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-13
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician