Provider Demographics
NPI:1598424194
Name:STEIN, WESLEY
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:STEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HUSKY CIRCLE
Mailing Address - Street 2:WOODHOUSE 314
Mailing Address - City:MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 HUSKY CIRCLE
Practice Address - Street 2:WOODHOUSE 314
Practice Address - City:MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06269
Practice Address - Country:US
Practice Address - Phone:203-957-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst