Provider Demographics
NPI:1659924686
Name:SHOBER, STACEY (BCBA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:SHOBER
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 1:247 MONTPELIER CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-4576
Mailing Address - Country:US
Mailing Address - Phone:240-446-4417
Mailing Address - Fax:
Practice Address - Street 1:8615 E VILLAGE AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-4316
Practice Address - Country:US
Practice Address - Phone:240-912-2220
Practice Address - Fax:301-926-9384
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-18-63218106S00000X
MD1-21-56137103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician