Provider Demographics
NPI:1114096781
Name:STEVENS, JOHN R (MS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 CAROL RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-3865
Mailing Address - Country:US
Mailing Address - Phone:717-755-0921
Mailing Address - Fax:717-751-0783
Practice Address - Street 1:2647 CARNEGIE RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-3786
Practice Address - Country:US
Practice Address - Phone:717-755-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004861L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01829801OtherCAPITAL BLUR CROSS
PA11626025OtherCAQH
PA447066OtherHIGHMARK BLUE SHIELD
PA0102338000OtherMAGELLAN HEALTH SERVICES
PA442031OtherVALUE OPTIONS