Provider Demographics
NPI:1457921769
Name:ASEMOTA, STACY (BCBA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:ASEMOTA
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 1:5626 GAINOR RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-3113
Mailing Address - Country:US
Mailing Address - Phone:856-693-6146
Mailing Address - Fax:
Practice Address - Street 1:4 MILL RUN CT
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2436
Practice Address - Country:US
Practice Address - Phone:609-440-5792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst