Provider Demographics
NPI:1538364336
Name:MCINTYRE, STACEY M (BCBA)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:M
Last Name:MCINTYRE
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 1:10101 GROSVENOR PL APT 1417
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4677
Mailing Address - Country:US
Mailing Address - Phone:301-538-8990
Mailing Address - Fax:
Practice Address - Street 1:9727 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1458
Practice Address - Country:US
Practice Address - Phone:202-420-8359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1-01-0645101Y00000X
MDLBA141103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor