Healthcare Provider Details

I. General information

NPI: 1275157497
Provider Name (Legal Business Name): STEPHEN HOURAN BEHNKE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MASSACHUSETTS MENTAL HEALTH CENTER 75 FENWOOD ROAD
BOSTON MA
02111
US

IV. Provider business mailing address

PO BOX 75232
WASHINGTON DC
20013-0232
US

V. Phone/Fax

Practice location:
  • Phone: 617-626-9300
  • Fax:
Mailing address:
  • Phone: 202-277-8780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6986-PY-PR
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: