Provider Demographics
NPI:1922032457
Name:STEVENS, ISABEL LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ISABEL
Middle Name:LYNN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-5000
Mailing Address - Country:US
Mailing Address - Phone:617-510-5883
Mailing Address - Fax:617-623-0392
Practice Address - Street 1:661 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-5000
Practice Address - Country:US
Practice Address - Phone:617-510-5883
Practice Address - Fax:617-623-0392
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7905103G00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06389OtherBCBS
MAW06389OtherBCBS