Provider Demographics
NPI:1477606598
Name:STOCKER, STEPHEN PAUL (MSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PAUL
Last Name:STOCKER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:876 DEVONSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1706
Mailing Address - Country:US
Mailing Address - Phone:586-420-3456
Mailing Address - Fax:248-348-2333
Practice Address - Street 1:315 N CENTER ST
Practice Address - Street 2:BOX 270
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1277
Practice Address - Country:US
Practice Address - Phone:586-420-3456
Practice Address - Fax:248-348-2333
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801001271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008900570OtherBLUE CROSS PROVIDER #
MI051735OtherVALUE OPTIONS PROVIDER #
MI0007019037OtherAETNA PROVIDER NUMBER
MI0007019037OtherAETNA PROVIDER NUMBER