Provider Demographics
NPI:1598036592
Name:WILLIAMS, STEPHANIE M (MUA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MUA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 RIVER ST
Mailing Address - Street 2:APARTMENT 23
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2973
Mailing Address - Country:US
Mailing Address - Phone:617-698-0344
Mailing Address - Fax:
Practice Address - Street 1:116 RIVER ST
Practice Address - Street 2:APARTMENT 23
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2973
Practice Address - Country:US
Practice Address - Phone:617-698-0344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K0000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst