=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720101702
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN QUINTANA TAYLOR PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 154 BROAD ST SUITE 1522
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03063-3205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-595-4448
-----------------------------------------------------
Fax | 978-692-3087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 KIRSI CIR
-----------------------------------------------------
City | WESTFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01886-2015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-692-6407
-----------------------------------------------------
Fax | 978-692-3087
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 4682
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 415
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------