Provider Demographics
NPI:1265452387
Name:VIEIRA, STEPHANIE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:VIEIRA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:DZIALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:151 ROCK ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-3201
Mailing Address - Country:US
Mailing Address - Phone:508-678-7542
Mailing Address - Fax:508-676-3699
Practice Address - Street 1:151 ROCK ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3201
Practice Address - Country:US
Practice Address - Phone:508-678-7542
Practice Address - Fax:508-676-3699
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MA1153791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor