Healthcare Provider Details

I. General information

NPI: 1396706826
Provider Name (Legal Business Name): STEPHANIE J NURENBERG LICSW; PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 SOUTH ST
NORTHAMPTON MA
01060-4111
US

IV. Provider business mailing address

289 SOUTH ST
NORTHAMPTON MA
01060-4111
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-3350
  • Fax:
Mailing address:
  • Phone: 413-586-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101512
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: