Individual
BROOKS STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
76 BEDFORD ST, SUITE 21, LEXINGTON, MA 02420-4646
(978) 340-3349
(978) 369-6877
Mailing address
76 BEDFORD ST, SUITE 21, LEXINGTON, MA 02420
(978) 340-3349
(978) 369-6877
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1025355
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1859757
—
MA
01
—
P22991
MEDICARE PTAN
LA
Enumeration date
10/06/2006
Last updated
04/30/2013
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