Provider Demographics
NPI:1790871135
Name:MANCINI-DUBREY, STEPHANIE LYNN (MSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:MANCINI-DUBREY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WELLS PARK RD
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1316
Mailing Address - Country:US
Mailing Address - Phone:774-272-5671
Mailing Address - Fax:774-568-5614
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:FISKDALE
Practice Address - State:MA
Practice Address - Zip Code:01518-1214
Practice Address - Country:US
Practice Address - Phone:774-272-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW015471041C0700X
MA1171641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISM60047Medicaid