Provider Demographics
NPI:1134677453
Name:JAMES, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7249 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21871-4009
Mailing Address - Country:US
Mailing Address - Phone:443-880-6345
Mailing Address - Fax:
Practice Address - Street 1:382 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CRISFIELD
Practice Address - State:MD
Practice Address - Zip Code:21817-1329
Practice Address - Country:US
Practice Address - Phone:410-968-3547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20945104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker