Healthcare Provider Details

I. General information

NPI: 1558282251
Provider Name (Legal Business Name): EVANGELINE DESPINA STEFANAKIS ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 MOUNT AUBURN ST APT 4
CAMBRIDGE MA
02138-5500
US

IV. Provider business mailing address

457 MOUNT AUBURN ST APT 4
CAMBRIDGE MA
02138-5500
US

V. Phone/Fax

Practice location:
  • Phone: 617-230-4200
  • Fax: 617-230-4200
Mailing address:
  • Phone: 617-230-4200
  • Fax: 617-230-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number184942
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: