Provider Demographics
NPI:1083615116
Name:DRIEZE, STEPHANIE B (LICSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:B
Last Name:DRIEZE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-6621
Mailing Address - Country:US
Mailing Address - Phone:978-462-2890
Mailing Address - Fax:978-462-2890
Practice Address - Street 1:8 THORNDIKE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5858
Practice Address - Country:US
Practice Address - Phone:978-462-2890
Practice Address - Fax:978-462-2890
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10187831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P05259Medicare ID - Type Unspecified