Provider Demographics
NPI:1780860312
Name:STEIN, SORAH (MA, BCBA, CSE)
Entity Type:Individual
Prefix:
First Name:SORAH
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:MA, BCBA, CSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 DONMOYER AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-1935
Mailing Address - Country:US
Mailing Address - Phone:574-234-9282
Mailing Address - Fax:574-234-9282
Practice Address - Street 1:751 DONMOYER AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-1935
Practice Address - Country:US
Practice Address - Phone:574-234-9282
Practice Address - Fax:574-234-9282
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4169103K00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174H00000XOther Service ProvidersHealth Educator