MEDICARE: BROOKS STEVENS LICSW

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	104100000X	Social Worker	1025355	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P22991	OTHER	LA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679660856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKS STEVENS LICSW

Provider Business Mailing Address
First Line	:	76 BEDFORD ST
Second Line	:	SUITE 21
City	:	LEXINGTON
State	:	MA
Zip	:	02420
Country	:	US
Telephone Number	:	978-340-3349
Fax Number	:	978-369-6877

Provider Business Practice Location Address
First Line	:	76 BEDFORD ST
Second Line	:	SUITE 21
City	:	LEXINGTON
State	:	MA
Zip	:	02420-4646
Country	:	US
Telephone Number	:	978-340-3349
Fax Number	:	978-369-6877

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	04/30/2013

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Directions to “ BROOKS STEVENS LICSW” Practice Location

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