MEDICARE: MR. STEPHEN C DUCLOS LMFT

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	106H00000X	Marriage & Family Therapist	1293	MA

General Provider Information

NPI Number	:	1629166418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN C DUCLOS LMFT

Provider Business Mailing Address
First Line	:	57 HARBORVIEW RD
Second Line	:
City	:	HULL
State	:	MA
Zip	:	02045-1213
Country	:	US
Telephone Number	:	781-925-2847
Fax Number	:	617-745-4170

Provider Business Practice Location Address
First Line	:	1354 HANCOCK ST
Second Line	:	SUITE 304
City	:	QUINCY
State	:	MA
Zip	:	02169-5109
Country	:	US
Telephone Number	:	617-745-4100
Fax Number	:	617-745-4170

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. STEPHEN C DUCLOS LMFT” Practice Location

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