Provider Demographics
NPI:1902397409
Name:STINE, STEPHANIE A (MS)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:A
Last Name:STINE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 WASHINGTON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2179
Mailing Address - Country:US
Mailing Address - Phone:717-679-2713
Mailing Address - Fax:
Practice Address - Street 1:70 EVERETT AVE STE 515
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2363
Practice Address - Country:US
Practice Address - Phone:617-466-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health