Provider Demographics
NPI:1356733752
Name:BAGGESE, STEVEN (BCBA)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:BAGGESE
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 1:5104 MOON LILY WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-4358
Mailing Address - Country:US
Mailing Address - Phone:408-460-2236
Mailing Address - Fax:877-810-7944
Practice Address - Street 1:5104 MOON LILY WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-4358
Practice Address - Country:US
Practice Address - Phone:408-460-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-14-16102103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst