Provider Demographics
NPI:1548269665
Name:FOLVEN, STEPHEN R (LICSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:R
Last Name:FOLVEN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-2811
Mailing Address - Country:US
Mailing Address - Phone:978-454-1559
Mailing Address - Fax:
Practice Address - Street 1:81 BRIDGE ST
Practice Address - Street 2:SUITE 215
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1270
Practice Address - Country:US
Practice Address - Phone:978-459-2306
Practice Address - Fax:978-453-9394
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111995LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME277610099Medicaid
R83957Medicare UPIN
MAP06552Medicare PIN
MEMM5690Medicare ID - Type Unspecified