Provider Demographics
NPI:1053869719
Name:STUBBS, AUTUMN (RBT)
Entity type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:
Last Name:STUBBS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MRS
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:ADDEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:11823 SWEET SERENITY LN UNIT 109
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-4550
Mailing Address - Country:US
Mailing Address - Phone:850-321-1211
Mailing Address - Fax:
Practice Address - Street 1:11823 SWEET SERENITY LN UNIT 109
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-4550
Practice Address - Country:US
Practice Address - Phone:850-321-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist