Provider Demographics
NPI:1669580973
Name:ABATE, STEPHANIE J (LICSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:ABATE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 PARKER ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-4033
Mailing Address - Country:US
Mailing Address - Phone:978-225-2250
Mailing Address - Fax:978-225-2251
Practice Address - Street 1:150 FEARING ST
Practice Address - Street 2:SUITE 13
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1941
Practice Address - Country:US
Practice Address - Phone:413-887-8187
Practice Address - Fax:413-230-3161
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME030851041C0700X
MA1139231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME03085OtherLICENSE NUMBER
MA113923OtherLICENSE NUMBER
MA000192301OtherMEDICARE PTAN MASSACHUSETTS
MA000192301OtherMEDICARE PTAN MASSACHUSETTS