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General NPI Number Information
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NPI Number | 1790504876
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Entity Type | Organization
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Legal Business Name | STEPHANIE FOSBENNER MD
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 259 MASS AVE
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City | ARLINGTON
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State | MA
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Zip | 02474-8406
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Country | US
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Telephone | 267-374-6747
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Fax |
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Provider Business Mailing Address
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Address Line | 21 CENTRAL ST
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City | ARLINGTON
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State | MA
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Zip | 02476-4801
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Country | US
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Telephone | 267-374-6747
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. STEPHANIE MORGAN FOSBENNER
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Credential | MD
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Telephone | 267-374-6747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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