Provider Demographics
NPI:1649644899
Name:STEWART MACOMBER, EMILY (LMHC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:STEWART MACOMBER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:0 GOVERNORS AVE STE 24
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3097
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:789 MASSACHUSETTS AVE STE 4
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-3927
Practice Address - Country:US
Practice Address - Phone:781-862-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health