=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407338296
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEFANIE TOVA LAKIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2018
-----------------------------------------------------
Last Update Date | 03/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 MAIN ST STE 14
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01890-2940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-218-2377
-----------------------------------------------------
Fax | 781-995-0462
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 540 MAIN ST STE 14
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01890-2940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-218-2377
-----------------------------------------------------
Fax | 781-995-0462
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 13125
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------