Provider Demographics
NPI:1811065956
Name:BILLINGHAM, STEPHANIE ANNE (LICSW, PHD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNE
Last Name:BILLINGHAM
Suffix:
Gender:F
Credentials:LICSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FOUNDRY ST
Mailing Address - Street 2:DURHAM 9
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1732
Mailing Address - Country:US
Mailing Address - Phone:508-238-4114
Mailing Address - Fax:508-238-4114
Practice Address - Street 1:448 TURNPIKE ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1776
Practice Address - Country:US
Practice Address - Phone:508-238-4114
Practice Address - Fax:508-238-4114
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1013381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO1423OtherLICSW LICENCE