Stephanie Tullock, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

010028 Issued in CT

Practice address

201 Chestnut Hill Rd
Stafford Springs, CT 06076-4005

Phone

(860) 684-8290

Fax

(860) 684-8179

NPI assigned

Jul 24, 2020

Last updated

Jul 24, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595548800000",
    "number": "1093324295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 CHESTNUT HILL RD",
            "city": "STAFFORD SPRINGS",
            "state": "CT",
            "postal_code": "060764005",
            "telephone_number": "860-684-8283",
            "fax_number": "860-684-8179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 CHESTNUT HILL RD",
            "city": "STAFFORD SPRINGS",
            "state": "CT",
            "postal_code": "060764005",
            "telephone_number": "860-684-8290",
            "fax_number": "860-684-8179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLOCK",
        "first_name": "STEPHANIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-24",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "010028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kristen Marie Wiese, R.PH

• Clinical Social Worker in Stafford Springs, CT
• Providers in Stafford Springs, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.