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NPI Code Detail

MEDICARE: DR. ERIC C STUBENHAUS PH.D.

MEDICARE: DR. ERIC C STUBENHAUS PH.D.
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
12084P0800XPsychiatry Physician4737MA
2103TC2200XClinical Child & Adolescent Psychologist4737MA
3103T00000XPsychologist4737MA
4106H00000XMarriage & Family Therapist4737MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588771547
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC C STUBENHAUS PH.D.
Provider Business Mailing Address
First Line : 3 DUNDEE PARK
Second Line : SUITE B05
City : ANDOVER
State : MA
Zip : 01810
Country : US
Telephone Number : 978-475-6622
Fax Number : 978-475-8436
Provider Business Practice Location Address
First Line : 3 DUNDEE PARK
Second Line : SUITE B05
City : ANDOVER
State : MA
Zip : 01810
Country : US
Telephone Number : 978-475-6622
Fax Number : 978-475-8436
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2006
Last Update Date : 03/20/2015

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Directions to “ DR. ERIC C STUBENHAUS PH.D.” Practice Location

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