Provider Demographics
NPI:1033504717
Name:STEPHENS, TAMMY H (LICSW)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:H
Last Name:STEPHENS
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-6009
Mailing Address - Country:US
Mailing Address - Phone:508-679-5222
Mailing Address - Fax:508-673-3182
Practice Address - Street 1:1010 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02724-2855
Practice Address - Country:US
Practice Address - Phone:508-235-5010
Practice Address - Fax:508-235-5053
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228364101Y00000X
MALICSW11400161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor