Healthcare Provider Details

I. General information

NPI: 1932016755
Provider Name (Legal Business Name): STACY LINA POGGENPOHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BOSTON POST RD W STE 101
MARLBOROUGH MA
01752-4667
US

IV. Provider business mailing address

47 SCHOOL ST
ACTON MA
01720-3627
US

V. Phone/Fax

Practice location:
  • Phone: 580-624-0304
  • Fax:
Mailing address:
  • Phone: 732-995-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW2144165
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: