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General NPI Number Information
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NPI Number | 1811466931
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Entity Type | Individual
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Provider Name | STEPHANE CHRISTINE BATES MA
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Gender | Female
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 780 AMERICAN LEGION HWY
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City | ROSLINDALE
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State | MA
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Zip | 02131-3908
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Country | US
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Telephone | 781-540-4252
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Fax |
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Provider Business Mailing Address
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Address Line | 191 KENRICK ST
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City | BRIGHTON
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State | MA
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Zip | 02135-3845
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Country | US
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Telephone | 619-808-4620
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number |
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License Number State |
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