1275656233 NPI number — DR. STEPHANIE T MACHELL PSY.D.

Table of content: DR. STEPHANIE T MACHELL PSY.D. (NPI 1275656233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275656233 NPI number — DR. STEPHANIE T MACHELL PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACHELL
Provider First Name:
STEPHANIE
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275656233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 CHURCHILL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAUGUS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01906-2535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-776-4001
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 WATSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELMONT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02478-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-776-4001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  7720 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC2200X , with the licence number: 7720 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TH0100X , with the licence number: 7720 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TR0400X , with the licence number: 7720 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0500224 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 406945 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W05932 . This is a "BLUE CROSS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".