Provider Demographics
NPI:1952608283
Name:STEVENSON, JOHN (TSE, TSHH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:TSE, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 LAKE AVENUE EXT
Mailing Address - Street 2:286
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5279
Mailing Address - Country:US
Mailing Address - Phone:516-769-5274
Mailing Address - Fax:516-706-1962
Practice Address - Street 1:42 LAKE AVENUE EXT
Practice Address - Street 2:286
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5279
Practice Address - Country:US
Practice Address - Phone:516-769-5274
Practice Address - Fax:516-706-1962
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20193329252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency