Provider Demographics
NPI:1013093608
Name:STEPHEN, MARY G (LICSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:G
Last Name:STEPHEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WEST ROAD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1947
Mailing Address - Country:US
Mailing Address - Phone:413-528-5034
Mailing Address - Fax:
Practice Address - Street 1:4 WEST ROAD
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1947
Practice Address - Country:US
Practice Address - Phone:413-528-5034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0040701041C0700X
MA10276731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140004070CT03OtherANTHEM BCBS
375424OtherMAGELLAN BEHAV HEALTH
MAP07685OtherBLUE CROSS BLUE SHIELD
MAP22241OtherMEDICARE
00PNAOtherMBH PARTNERSHIP
000000025418OtherBMC HEALTHNET
00419326OtherCT BEHAV HLTH PARTNERSHIP
218483OtherMHN HMC
P2111426OtherOXFORD