Provider Demographics
NPI:1902380561
Name:SAMELA, STEPHEN (BCBA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:SAMELA
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-3449
Mailing Address - Country:US
Mailing Address - Phone:203-804-8772
Mailing Address - Fax:
Practice Address - Street 1:187 HALF MILE RD
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-4121
Practice Address - Country:US
Practice Address - Phone:203-239-6425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT581103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst