Provider Demographics
NPI:1396472312
Name:STANG, MAYA OLIVIA (BCBA)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:OLIVIA
Last Name:STANG
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 1:5 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1315
Mailing Address - Country:US
Mailing Address - Phone:315-240-1997
Mailing Address - Fax:
Practice Address - Street 1:5 ELM ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1315
Practice Address - Country:US
Practice Address - Phone:315-240-1997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst