Provider Demographics
NPI:1396017059
Name:FEARNLEY, STEPHEN (CADC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:FEARNLEY
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TER HEUN DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2525
Mailing Address - Country:US
Mailing Address - Phone:508-563-2262
Mailing Address - Fax:508-563-2660
Practice Address - Street 1:111 TORREY ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4800
Practice Address - Country:US
Practice Address - Phone:508-584-5190
Practice Address - Fax:508-584-7884
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1479AD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)