Healthcare Provider Details

I. General information

NPI: 1972301034
Provider Name (Legal Business Name): STEPHANIE ERNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEADOWBROOK RD
BROCKTON MA
02301-7122
US

IV. Provider business mailing address

10 MEADOWBROOK RD
BROCKTON MA
02301-7122
US

V. Phone/Fax

Practice location:
  • Phone: 508-584-9210
  • Fax:
Mailing address:
  • Phone: 508-584-9210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: