Provider Demographics
NPI:1952814808
Name:STEVENS, STEVIE SEAMUS
Entity Type:Individual
Prefix:MISS
First Name:STEVIE
Middle Name:SEAMUS
Last Name:STEVENS
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 1:47 ENGLEWOOD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7852
Mailing Address - Country:US
Mailing Address - Phone:954-850-2125
Mailing Address - Fax:
Practice Address - Street 1:47 ENGLEWOOD AVE APT 1
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-7852
Practice Address - Country:US
Practice Address - Phone:954-850-2125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician