Provider Demographics
NPI:1134694920
Name:STEFANIAK, ANNE B (LICSW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:B
Last Name:STEFANIAK
Suffix:
Gender:F
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:PO BOX 75
Mailing Address - Street 2:10 PLEASANT ST
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516-0075
Mailing Address - Country:US
Mailing Address - Phone:508-341-2875
Mailing Address - Fax:
Practice Address - Street 1:10 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:MA
Practice Address - Zip Code:01516-0075
Practice Address - Country:US
Practice Address - Phone:508-341-2875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW10180101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical