Provider Demographics
NPI:1912062571
Name:NOSTIN, STEPHANIE DENISE (MS, CCC-SLP, BCBA,)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DENISE
Last Name:NOSTIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP, BCBA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 BROADWAY SPC 210
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-2387
Mailing Address - Country:US
Mailing Address - Phone:774-804-1285
Mailing Address - Fax:
Practice Address - Street 1:375 BROADWAY SPC 210
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940
Practice Address - Country:US
Practice Address - Phone:774-804-1285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-10-7827103K00000X
MA217640235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst