Provider Demographics
NPI:1952891228
Name:MARTIN, STEPHANIE ANN (NASP, LEP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NASP, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2433
Mailing Address - Country:US
Mailing Address - Phone:608-632-1165
Mailing Address - Fax:
Practice Address - Street 1:132 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-2433
Practice Address - Country:US
Practice Address - Phone:608-632-1165
Practice Address - Fax:508-634-6984
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-13
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222Q00000X
MALEP10000022103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist