Provider Demographics
NPI:1689292096
Name:STEVENS, JOHN (MDIV)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:JOHNNY
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MDIV
Mailing Address - Street 1:166 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-1620
Mailing Address - Country:US
Mailing Address - Phone:617-869-2816
Mailing Address - Fax:
Practice Address - Street 1:166 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:REHOBOTH
Practice Address - State:MA
Practice Address - Zip Code:02769-1620
Practice Address - Country:US
Practice Address - Phone:617-869-2816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral