Provider Demographics
NPI:1275656233
Name:MACHELL, STEPHANIE T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:T
Last Name:MACHELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CHURCHILL ST
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-2535
Mailing Address - Country:US
Mailing Address - Phone:617-776-4001
Mailing Address - Fax:
Practice Address - Street 1:5 WATSON RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-3924
Practice Address - Country:US
Practice Address - Phone:617-776-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7720103TC0700X, 103TC2200X, 103TH0100X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0500224Medicaid
MA406945OtherTUFTS HEALTH PLAN
MAW05932OtherBLUE CROSS OF MA
MAW05932OtherBLUE CROSS OF MA