Individual
STEPHEN LO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(866) 602-1448
Mailing address
555 W MADISON ST APT 606, CHICAGO, IL 60661-2517
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY10000066
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/27/2022
Last updated
11/17/2023
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