Provider Demographics
NPI:1831262245
Name:AMIRA, STEPHEN ALAN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALAN
Last Name:AMIRA
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:57 MONTVALE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1361
Mailing Address - Country:US
Mailing Address - Phone:617-527-7807
Mailing Address - Fax:617-566-1719
Practice Address - Street 1:1101 BEACON ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-527-0693
Practice Address - Fax:617-566-1719
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2008-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA3233103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1831262245Medicare PIN