1558461244 NPI number — DR. STEPHANIE SHORT SIDNEY PSY.D.

Table of content: DR. STEPHANIE SHORT SIDNEY PSY.D. (NPI 1558461244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558461244 NPI number — DR. STEPHANIE SHORT SIDNEY PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIDNEY
Provider First Name:
STEPHANIE
Provider Middle Name:
SHORT
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:
SHORT
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
LUCINDA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558461244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 345
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOXFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01921-0345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-887-2977
Provider Business Mailing Address Fax Number:
978-887-5822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 GEORGETOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOXFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01921-2333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-887-2977
Provider Business Practice Location Address Fax Number:
978-887-5822
Provider Enumeration Date:
09/23/2006

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:  3398 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5134232 . This is a "AETNA PIN #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 34896 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 44154653 . This is a "TEAMSTERS TAX ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W03470 . This is a "BC/BS PIN #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 007970 . This is a "VALUE OPTIONS TAX ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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