MEDICARE: MR. ROBERT C STEVENS MED

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	101YM0800X	Mental Health Counselor	5855	MA

General Provider Information

NPI Number	:	1811098080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT C STEVENS MED

Provider Business Mailing Address
First Line	:	PO BOX 752
Second Line	:	245 RUSSELL STREET
City	:	HADLEY
State	:	MA
Zip	:	01035-0752
Country	:	US
Telephone Number	:	413-586-8485
Fax Number	:	413-303-9666

Provider Business Practice Location Address
First Line	:	245 RUSSELL ST
Second Line	:	SUITE 19
City	:	HADLEY
State	:	MA
Zip	:	01035-9529
Country	:	US
Telephone Number	:	413-586-8485
Fax Number	:

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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