Provider Demographics
NPI:1922488600
Name:STEVENS, MICHELLE C
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:C
Other - Last Name:DEVINCENTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 PHINNEY ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-2061
Mailing Address - Country:US
Mailing Address - Phone:978-810-9818
Mailing Address - Fax:
Practice Address - Street 1:15 PHINNEY ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-2061
Practice Address - Country:US
Practice Address - Phone:978-810-9818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMF7716106H00000X
1041C0700X, 106H00000X
CA115286106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical