Provider Demographics
NPI:1558478339
Name:STEPHENS, DOUGLAS B (LICSW)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:B
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-1001
Mailing Address - Country:US
Mailing Address - Phone:518-747-2994
Mailing Address - Fax:518-747-2996
Practice Address - Street 1:15 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1001
Practice Address - Country:US
Practice Address - Phone:518-747-2994
Practice Address - Fax:518-747-2996
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR058282-11041C0700X
NY000344106H00000X
NH1542106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical