Provider Demographics
NPI:1477264893
Name:MIS, STEPHANIE TAYLOR
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TAYLOR
Last Name:MIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CRABAPPLE DR
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02779-1132
Mailing Address - Country:US
Mailing Address - Phone:774-226-3350
Mailing Address - Fax:
Practice Address - Street 1:11 CRABAPPLE DR
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MA
Practice Address - Zip Code:02779-1132
Practice Address - Country:US
Practice Address - Phone:774-226-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor