Healthcare Provider Details

I. General information

NPI: 1174939698
Provider Name (Legal Business Name): STEPHANIE MARRERO-WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 MASSACHUSETTS AVE
SPRINGFIELD MA
01109-3238
US

IV. Provider business mailing address

173 MASSACHUSETTS AVE
SPRINGFIELD MA
01109-3238
US

V. Phone/Fax

Practice location:
  • Phone: 413-297-7033
  • Fax:
Mailing address:
  • Phone: 413-297-7033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128179
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: