1013093608 NPI number — MS. MARY G STEPHEN LICSW

Table of content: MS. MARY G STEPHEN LICSW (NPI 1013093608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013093608 NPI number — MS. MARY G STEPHEN LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEPHEN
Provider First Name:
MARY
Provider Middle Name:
G
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1013093608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 WEST ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT BARRINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01230-1947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-528-5034
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 WEST ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREAT BARRINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01230-1947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-528-5034
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2006

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: 1041C0700X , with the licence number:  004070 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 1027673 , 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: 140004070CT03 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 375424 . This is a "MAGELLAN BEHAV HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P07685 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P22241 . This is a "MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 00PNA . This is a "MBH PARTNERSHIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000025418 . This is a "BMC HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00419326 . This is a "CT BEHAV HLTH PARTNERSHIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 218483 . This is a "MHN HMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2111426 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com