Provider Demographics
NPI:1366618720
Name:STEVENS, JENNIFER L (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 962
Mailing Address - Street 2:25 MAIN STREET
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01262-0962
Mailing Address - Country:US
Mailing Address - Phone:413-931-5275
Mailing Address - Fax:413-298-4029
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:#217
Practice Address - City:STOCKBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01262
Practice Address - Country:US
Practice Address - Phone:413-931-5275
Practice Address - Fax:413-298-4029
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016067103TC0700X, 103T00000X, 102L00000X
MA7993103T00000X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM7971Medicare PIN