Provider Demographics
NPI:1356743884
Name:CARLSON, STEPHANIE JOYCE (MED, LMHC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOYCE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JOYCE
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 WEST ST.
Mailing Address - Street 2:SUITE 33
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527
Mailing Address - Country:US
Mailing Address - Phone:508-471-7022
Mailing Address - Fax:774-241-8545
Practice Address - Street 1:545 WESTMINSTER ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4727
Practice Address - Country:US
Practice Address - Phone:978-829-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor