Organization
CHILD DEVELOPMENT NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JANINE KORAHAIS STASIOR PHD, MS (NEUROPSYCHOLOGIST, BUSINESS OWNER)
(781) 861-6655
Entity
Organization
Contact information
Practice address
76 BEDFORD ST STE 12, LEXINGTON, MA 02420-4640
(781) 861-6655
(781) 861-6654
Mailing address
76 BEDFORD ST STE 12, LEXINGTON, MA 02420-4640
(781) 861-6655
(781) 861-6654
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W10652
BLUE CROSS BLUE SHIELD
MA
Enumeration date
01/26/2007
Last updated
08/22/2020
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