Provider Demographics
NPI:1558461244
Name:SIDNEY, STEPHANIE SHORT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:SHORT
Last Name:SIDNEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:LUCINDA
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-0345
Mailing Address - Country:US
Mailing Address - Phone:978-887-2977
Mailing Address - Fax:978-887-5822
Practice Address - Street 1:24 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BOXFORD
Practice Address - State:MA
Practice Address - Zip Code:01921-2333
Practice Address - Country:US
Practice Address - Phone:978-887-2977
Practice Address - Fax:978-887-5822
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3398103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5134232OtherAETNA PIN #
MA34896OtherCIGNA
MA44154653OtherTEAMSTERS TAX ID
MAW03470OtherBC/BS PIN #
MA007970OtherVALUE OPTIONS TAX ID
MA44154653OtherTEAMSTERS TAX ID