Healthcare Provider Details

I. General information

NPI: 1093658056
Provider Name (Legal Business Name): TEA STEPHENSON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 MAIN ST FL 400
SPRINGFIELD MA
01103-1063
US

IV. Provider business mailing address

532 JACARANDA ST
BRENTWOOD CA
94513-6354
US

V. Phone/Fax

Practice location:
  • Phone: 413-739-5572
  • Fax: 413-739-9972
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: