Healthcare Provider Details

I. General information

NPI: 1376266312
Provider Name (Legal Business Name): STEPHANIE A ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 OSBORN ST
FALL RIVER MA
02724-2814
US

IV. Provider business mailing address

61 INDUSTRIAL PARK RD
PLYMOUTH MA
02360-7246
US

V. Phone/Fax

Practice location:
  • Phone: 508-676-5708
  • Fax: 508-676-0148
Mailing address:
  • Phone: 508-927-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10006527
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: