Provider Demographics
NPI:1275157497
Name:BEHNKE, STEPHEN HOURAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:HOURAN
Last Name:BEHNKE
Suffix:
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:PO BOX 75232
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20013-0232
Mailing Address - Country:US
Mailing Address - Phone:202-277-8780
Mailing Address - Fax:
Practice Address - Street 1:MASSACHUSETTS MENTAL HEALTH CENTER
Practice Address - Street 2:75 FENWOOD ROAD
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-626-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6986-PY-PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical