Provider Demographics
NPI:1629335898
Name:CONSIDINE, STACEY ANN (MSED BCBA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:CONSIDINE
Suffix:
Gender:F
Credentials:MSED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COMSTOCK PKWY
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921-2002
Mailing Address - Country:US
Mailing Address - Phone:401-632-0264
Mailing Address - Fax:
Practice Address - Street 1:111 COMSTOCK PKWY
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02921-2002
Practice Address - Country:US
Practice Address - Phone:401-632-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1-04-1489103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst