Healthcare Provider Details

I. General information

NPI: 1003547159
Provider Name (Legal Business Name): SARAH NICOLE STANLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WARREN ST
BRIGHTON MA
02135-3601
US

IV. Provider business mailing address

77 WARREN ST
BRIGHTON MA
02135-3601
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-1271
  • Fax: 617-782-7668
Mailing address:
  • Phone: 617-254-1271
  • Fax: 617-782-7668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: