MEDICARE: JOANNE MARIE STEVENS L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	005728	CT

General Provider Information

NPI Number	:	1407010549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE MARIE STEVENS L.C.S.W.

Provider Business Mailing Address
First Line	:	91 BARNDOOR HILLS RD
Second Line	:
City	:	GRANBY
State	:	CT
Zip	:	06035-2916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	91 BARNDOOR HILLS RD
Second Line	:
City	:	GRANBY
State	:	CT
Zip	:	06035-2916
Country	:	US
Telephone Number	:	860-798-5530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/17/2008

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