1356743884 NPI number — STEPHANIE JOYCE CARLSON M.ED, LMHC

Table of content: STEPHANIE JOYCE CARLSON M.ED, LMHC (NPI 1356743884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356743884 NPI number — STEPHANIE JOYCE CARLSON M.ED, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLSON
Provider First Name:
STEPHANIE
Provider Middle Name:
JOYCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIRANDA
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
JOYCE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356743884
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 WEST ST.
Provider Second Line Business Mailing Address:
SUITE 33
Provider Business Mailing Address City Name:
MILLBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-471-7022
Provider Business Mailing Address Fax Number:
774-241-8545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
545 WESTMINSTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FITCHBURG
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01420-4727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-829-2260
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2014

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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