Provider Demographics
NPI:1851839757
Name:TRUMAN, STEPHANIE E
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:TRUMAN
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 1:78 BEECHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:ME
Mailing Address - Zip Code:04861-3621
Mailing Address - Country:US
Mailing Address - Phone:207-354-8184
Mailing Address - Fax:
Practice Address - Street 1:78 BEECHWOOD ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:ME
Practice Address - Zip Code:04861-3621
Practice Address - Country:US
Practice Address - Phone:207-354-8184
Practice Address - Fax:207-354-0487
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities