Provider Demographics
NPI:1770881963
Name:STUBER, TAMINA A (BCBA)
Entity type:Individual
Prefix:
First Name:TAMINA
Middle Name:A
Last Name:STUBER
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 1:29240 BUCKINGHAM ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4575
Mailing Address - Country:US
Mailing Address - Phone:866-752-0899
Mailing Address - Fax:203-604-0602
Practice Address - Street 1:29240 BUCKINGHAM ST
Practice Address - Street 2:STE. 1
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4575
Practice Address - Country:US
Practice Address - Phone:866-752-0899
Practice Address - Fax:203-604-0602
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4531103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst