Healthcare Provider Details

I. General information

NPI: 1427405521
Provider Name (Legal Business Name): STEPHANIE DELEON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 PONDVIEW DR
AMHERST MA
01002-3231
US

IV. Provider business mailing address

245 PONDVIEW DR
AMHERST MA
01002-3231
US

V. Phone/Fax

Practice location:
  • Phone: 401-830-3065
  • Fax:
Mailing address:
  • Phone: 401-830-3065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1141079
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04465
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: