Provider Demographics
NPI:1679964183
Name:POULIOT, STEFFANI LYNNE (LICSW)
Entity type:Individual
Prefix:
First Name:STEFFANI
Middle Name:LYNNE
Last Name:POULIOT
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-3398
Mailing Address - Country:US
Mailing Address - Phone:315-247-1589
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 93
Practice Address - Street 2:
Practice Address - City:HATHORNE
Practice Address - State:MA
Practice Address - Zip Code:01937-0193
Practice Address - Country:US
Practice Address - Phone:315-247-1589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA123196101YM0800X, 1041C0700X
NH50671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health