Provider Demographics
NPI:1265875371
Name:STOLZE, MEGAN RAE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:RAE
Last Name:STOLZE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2552
Mailing Address - Country:US
Mailing Address - Phone:617-440-1615
Mailing Address - Fax:617-442-2589
Practice Address - Street 1:36 DEARBORN ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-2552
Practice Address - Country:US
Practice Address - Phone:617-440-1615
Practice Address - Fax:617-442-2589
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2185841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical