Provider Demographics
NPI:1053812735
Name:PRANTIS, STEPHANIE F (LICSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:F
Last Name:PRANTIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:KOGUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 HOLLIS ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1235
Mailing Address - Country:US
Mailing Address - Phone:603-626-9500
Mailing Address - Fax:603-935-5392
Practice Address - Street 1:1245 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1308
Practice Address - Country:US
Practice Address - Phone:603-668-6629
Practice Address - Fax:603-935-5392
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical