Provider Demographics
NPI:1164847448
Name:LOVEJOY, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LOVEJOY
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 1:710 BUCKSPORT RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2722
Mailing Address - Country:US
Mailing Address - Phone:207-667-6890
Mailing Address - Fax:207-667-6457
Practice Address - Street 1:710 BUCKSPORT RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2722
Practice Address - Country:US
Practice Address - Phone:207-667-6890
Practice Address - Fax:207-667-6457
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1164847448Medicaid