Provider Demographics
NPI:1639795271
Name:LIBMAN, BASHA MICHELLE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:BASHA
Middle Name:MICHELLE
Last Name:LIBMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:BENJAMIN
Other - Middle Name:MICHAEL
Other - Last Name:LIBMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4893 EAST BELTLINE AVE NE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525
Mailing Address - Country:US
Mailing Address - Phone:616-279-6414
Mailing Address - Fax:616-591-3393
Practice Address - Street 1:201 KING OF PRUSSIA RD STE 650
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5156
Practice Address - Country:US
Practice Address - Phone:215-853-6682
Practice Address - Fax:616-591-3393
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst