Provider Demographics
NPI:1770664112
Name:EMMETT, STEVEN WILEY (REV, PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WILEY
Last Name:EMMETT
Suffix:
Gender:M
Credentials:REV, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 TICHNOR PL
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-3916
Mailing Address - Country:US
Mailing Address - Phone:781-545-6131
Mailing Address - Fax:781-545-6131
Practice Address - Street 1:36 TICHNOR PL
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-3916
Practice Address - Country:US
Practice Address - Phone:781-545-6131
Practice Address - Fax:781-545-6131
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2792103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist