Provider Demographics
NPI:1821522988
Name:STEIN, SUERAE
Entity Type:Individual
Prefix:
First Name:SUERAE
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUERAE
Other - Middle Name:
Other - Last Name:COBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 SCHOOL ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2781
Mailing Address - Country:US
Mailing Address - Phone:978-632-9400
Mailing Address - Fax:
Practice Address - Street 1:205 SCHOOL ST
Practice Address - Street 2:SUITE 301
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2781
Practice Address - Country:US
Practice Address - Phone:978-632-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-16
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health