Stephanie M Blackburn, MED LMHC
Individual provider Active NPI Psychologist · South Easton, MA
NPI 1568522282 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1568522282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 5679 (MA)
- Practice address
- 45 Eastman Street
South Easton, MA 02375 - Phone
- (508) 238-5766
- Fax
- (508) 238-8045
- NPI assigned
- Dec 11, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5679 | MA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mass Bay Enterprises LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 5679 | MA | Yes |
Addresses
Primary practice location
45 Eastman Street
South Easton, MA 02375
Mailing address
45 Eastman Street
South Easton, MA 02375
Phone (508) 238-5766
Other names
- Stephanie Lynn Martin
Other providers in South Easton, MA
- Beacon Psychiatry PLLC
- Peter Bellas
- Madison Bergantim
- Stephanie Anne Billingham
- Dean Albert Blackburn
- Jaclyn Kendall Bliss
- Michael James Boylan
- Mallory Joelyn Breen
- Julie Perry Breton
- Sara Brewer
All providers in South Easton, MA · Psychologist in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.