MEDICARE: STEPHANIE JEAN

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	104100000X	MA

General Provider Information

NPI Number	:	1730310889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE JEAN

Provider Business Mailing Address
First Line	:	156 GARDNER ST
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-3802
Country	:	US
Telephone Number	:	781-715-5859
Fax Number	:

Provider Business Practice Location Address
First Line	:	156 GARDNER ST
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-3802
Country	:	US
Telephone Number	:	781-715-5859
Fax Number	:

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

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	08/06/2009

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Directions to “ STEPHANIE JEAN ” Practice Location

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