Healthcare Provider Details

I. General information

NPI: 1447113881
Provider Name (Legal Business Name): STILLWATER THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 COMMERCIAL ST
PROVINCETOWN MA
02657-2439
US

IV. Provider business mailing address

508 COMMERCIAL ST
PROVINCETOWN MA
02657-2439
US

V. Phone/Fax

Practice location:
  • Phone: 774-643-0409
  • Fax:
Mailing address:
  • Phone: 774-643-0409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HEATHER DIANA BAKER
Title or Position: OWNER
Credential: LMHC
Phone: 617-694-5511