Healthcare Provider Details

I. General information

NPI: 1003348228
Provider Name (Legal Business Name): BRIAN JAMES STEVENSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS RD PSYCHOLOGY DEPARTMENT
BEDFORD MA
01730-1114
US

IV. Provider business mailing address

200 SPRINGS RD PSYCHOLOGY DEPARTMENT
BEDFORD MA
01730-1114
US

V. Phone/Fax

Practice location:
  • Phone: 781-687-3919
  • Fax:
Mailing address:
  • Phone: 781-687-3919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number10765
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: