Provider Demographics
NPI:1720101702
Name:TAYLOR, STEPHEN QUINTANA (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:QUINTANA
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 KIRSI CIR
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-2015
Mailing Address - Country:US
Mailing Address - Phone:978-692-6407
Mailing Address - Fax:978-692-3087
Practice Address - Street 1:154 BROAD ST
Practice Address - Street 2:SUITE 1522
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-3205
Practice Address - Country:US
Practice Address - Phone:603-595-4448
Practice Address - Fax:978-692-3087
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4682103T00000X
NH415103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist