Provider Demographics
NPI:1457872475
Name:MAURTUA, STEFANIE PAOLA (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:STEFANIE
Middle Name:PAOLA
Last Name:MAURTUA
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 1:2448 W BLOOMINGDALE AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6920
Mailing Address - Country:US
Mailing Address - Phone:630-550-6932
Mailing Address - Fax:
Practice Address - Street 1:2448 WEST BLOOMINGDALE AVE.
Practice Address - Street 2:APT 2E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647
Practice Address - Country:US
Practice Address - Phone:630-550-6932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBACB288453103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst