Provider Demographics
NPI:1568645018
Name:WUEBBENS, STEPHANIE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:A
Last Name:WUEBBENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2953
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02584-2953
Mailing Address - Country:US
Mailing Address - Phone:508-325-7754
Mailing Address - Fax:
Practice Address - Street 1:30 ESSEX RD
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-4390
Practice Address - Country:US
Practice Address - Phone:508-325-7743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6418103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist