Provider Demographics
NPI:1205296506
Name:SYLVIA, STEPHANIE (BA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SYLVIA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SYLVIA COSTELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:22 STRAFFORD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-4702
Mailing Address - Country:US
Mailing Address - Phone:603-366-1070
Mailing Address - Fax:
Practice Address - Street 1:22 STRAFFORD ST STE 1
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-4702
Practice Address - Country:US
Practice Address - Phone:603-366-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool