Provider Demographics
NPI:1366823098
Name:THROWER, STEPHANIE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:J
Last Name:THROWER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:PAULK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:10 TOWER OFFICE PARK STE 212
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2120
Mailing Address - Country:US
Mailing Address - Phone:617-463-9484
Mailing Address - Fax:
Practice Address - Street 1:10 TOWER OFFICE PARK STE 212
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2120
Practice Address - Country:US
Practice Address - Phone:617-463-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2019-08-14
Deactivation Date:2019-07-16
Deactivation Code:
Reactivation Date:2019-07-24
Provider Licenses
StateLicense IDTaxonomies
MA11096103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling