Provider Demographics
NPI:1164906285
Name:STEBBINS, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:STEBBINS
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 1:38 PLEASANT VIEW RD
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-2756
Mailing Address - Country:US
Mailing Address - Phone:413-237-4480
Mailing Address - Fax:
Practice Address - Street 1:38 PLEASANT VIEW RD
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-2756
Practice Address - Country:US
Practice Address - Phone:413-237-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10209251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical