Provider Demographics
NPI:1811098080
Name:STEVENS, ROBERT C (MED)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:245 RUSSELL STREET
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-0752
Mailing Address - Country:US
Mailing Address - Phone:413-586-8485
Mailing Address - Fax:413-303-9666
Practice Address - Street 1:245 RUSSELL ST
Practice Address - Street 2:SUITE 19
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9529
Practice Address - Country:US
Practice Address - Phone:413-586-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health