Healthcare Provider Details

I. General information

NPI: 1396672796
Provider Name (Legal Business Name): STEPHANIE AUDIFRE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 MILTON ST
LAWRENCE MA
01841-4230
US

IV. Provider business mailing address

31 MILTON ST
LAWRENCE MA
01841-4230
US

V. Phone/Fax

Practice location:
  • Phone: 978-802-8990
  • Fax:
Mailing address:
  • Phone: 978-802-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18976
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: