Provider Demographics
NPI:1750458030
Name:STEIN, JEFFREY D (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:STEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 WASHINGTON ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3518
Mailing Address - Country:US
Mailing Address - Phone:978-740-3100
Mailing Address - Fax:
Practice Address - Street 1:70 WASHINGTON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3518
Practice Address - Country:US
Practice Address - Phone:978-740-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8048103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic