Stacey Shober, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-56137 Issued in MD

Practice address

8615 E Village Ave
Montgomery Village, MD 20886-4316

Phone

(240) 912-2220

Fax

(301) 926-9384

NPI assigned

Jul 18, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Csaac, Inc.

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Montgomery Village, MD
  • NPI 1225137912
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648512000000",
    "number": "1659924686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 MONTPELIER CT",
            "city": "WESTMINSTER",
            "state": "MD",
            "postal_code": "211574576",
            "telephone_number": "240-446-4417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8615 E VILLAGE AVE",
            "city": "MONTGOMERY VILLAGE",
            "state": "MD",
            "postal_code": "208864316",
            "telephone_number": "240-912-2220",
            "fax_number": "301-926-9384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOBER",
        "first_name": "STACEY",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-18",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "MD",
            "license": "RBT-18-63218",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MD",
            "license": "1-21-56137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathaniel Addison Sawyer, LCSW-C
• Victoria Haleem Schwarzenberg, CRNP
• Brittany Scriber, LCPC
• Jenn Wang Sellers, MD
• Sherwin a Kevy DDS PC
• Shore Health Services LLC
• Tiffany Singletary
• Ariel Smallcomb
• Speech & Language Rehab Services LLC
• Samantha Stanford

• All providers in Montgomery Village, MD
• Behavior Analyst in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.