Provider Demographics
NPI:1972662468
Name:STOCKWELL, JAMES EDWARD (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:STOCKWELL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-1409
Mailing Address - Country:US
Mailing Address - Phone:978-887-5546
Mailing Address - Fax:978-887-5546
Practice Address - Street 1:18 S MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:TOPSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01983-1800
Practice Address - Country:US
Practice Address - Phone:978-887-5546
Practice Address - Fax:978-887-5546
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10297451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1890620Medicaid
MASTP20923Medicare ID - Type Unspecified
MAP07442Medicare UPIN
MA1890620Medicaid