Provider Demographics
NPI:1740601624
Name:INFANTE, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:INFANTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 TRACY AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-2149
Mailing Address - Country:US
Mailing Address - Phone:781-595-5196
Mailing Address - Fax:
Practice Address - Street 1:181 UNION ST
Practice Address - Street 2:SUITE J
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1311
Practice Address - Country:US
Practice Address - Phone:781-244-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS16341594103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent