Provider Demographics
NPI:1356973671
Name:STANSBERRY, MADELINE SKY (RBT)
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:SKY
Last Name:STANSBERRY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21291 E MAYA RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5530
Mailing Address - Country:US
Mailing Address - Phone:480-370-1479
Mailing Address - Fax:
Practice Address - Street 1:2451 E BASELINE RD STE 420
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2472
Practice Address - Country:US
Practice Address - Phone:480-474-4173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-20-111080106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician