Healthcare Provider Details

I. General information

NPI: 1811616758
Provider Name (Legal Business Name): KATERINA D STEPALAVICH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 RIVER ST STE 1
WALTHAM MA
02453-5483
US

IV. Provider business mailing address

431 RIVER ST STE 1
WALTHAM MA
02453-5483
US

V. Phone/Fax

Practice location:
  • Phone: 781-966-0597
  • Fax: 781-701-8905
Mailing address:
  • Phone: 781-966-0597
  • Fax: 781-701-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10004758
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: