MEDICARE: DR. STEPHANIE J NURENBERG LICSW; PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	101512	MA

General Provider Information

NPI Number	:	1396706826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE J NURENBERG LICSW; PHD

Provider Business Mailing Address
First Line	:	289 SOUTH ST
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-4111
Country	:	US
Telephone Number	:	413-586-3350
Fax Number	:

Provider Business Practice Location Address
First Line	:	289 SOUTH ST
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-4111
Country	:	US
Telephone Number	:	413-586-3350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2006
Last Update Date	:	07/08/2007

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