Provider Demographics
NPI:1750707147
Name:LAYER, STACY A (MA, BCBA)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:LAYER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7543
Mailing Address - Country:US
Mailing Address - Phone:954-654-2146
Mailing Address - Fax:954-416-2445
Practice Address - Street 1:200 SE 19TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7543
Practice Address - Country:US
Practice Address - Phone:954-654-2146
Practice Address - Fax:954-416-2445
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1084905103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst