Provider Demographics
NPI:1578293080
Name:STAHMER, MADDISON PASSION (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MADDISON
Middle Name:PASSION
Last Name:STAHMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MADDISON
Other - Middle Name:PASSION
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:267 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-1526
Mailing Address - Country:US
Mailing Address - Phone:508-273-6284
Mailing Address - Fax:
Practice Address - Street 1:267 OAK ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-1526
Practice Address - Country:US
Practice Address - Phone:508-273-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228054104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker