Provider Demographics
NPI:1194827634
Name:STAHL, JOHN RODERICK JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RODERICK
Last Name:STAHL
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2725
Mailing Address - Country:US
Mailing Address - Phone:508-822-0006
Mailing Address - Fax:508-880-5389
Practice Address - Street 1:7 DEAN ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2725
Practice Address - Country:US
Practice Address - Phone:508-822-0006
Practice Address - Fax:508-880-5389
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1830103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA94690OtherMHN
MA000953OtherHARVARDPILGRIMHEALTHCARE
MA000953OtherVALUE OPTIONS
MA5904732OtherAETNA
MAS018364OtherCHAMPUS
MA61-09958OtherUBH/UNITED HEALTHCARE
MASTW02009OtherBCBS MA
MA0503080Medicaid
MA705734OtherTUFTS HEALTHCARE
MA213470OtherBEACON
RI30261-0OtherBCBS RI
MA0503080Medicaid