Provider Demographics
NPI:1205996774
Name:STILPHEN, BETH B (LCPC)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:B
Last Name:STILPHEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LONGFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-2204
Mailing Address - Country:US
Mailing Address - Phone:207-767-4663
Mailing Address - Fax:207-874-8290
Practice Address - Street 1:92 DEERING AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2901
Practice Address - Country:US
Practice Address - Phone:207-874-8140
Practice Address - Fax:207-874-8290
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2214101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional