Provider Demographics
NPI:1871825158
Name:STEVENS, JOSLIN TYLER (LIC,AC)
Entity Type:Individual
Prefix:MRS
First Name:JOSLIN
Middle Name:TYLER
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LIC,AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:MA
Mailing Address - Zip Code:01351-9716
Mailing Address - Country:US
Mailing Address - Phone:413-387-8137
Mailing Address - Fax:
Practice Address - Street 1:110 N HILLSIDE RD
Practice Address - Street 2:SUITE 24
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-9726
Practice Address - Country:US
Practice Address - Phone:413-387-8137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237897171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist