Provider Demographics
NPI:1790504876
Name:STEPHANIE FOSBENNER MD
Entity type:Organization
Organization Name:STEPHANIE FOSBENNER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:FOSBENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-374-6747
Mailing Address - Street 1:21 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4801
Mailing Address - Country:US
Mailing Address - Phone:267-374-6747
Mailing Address - Fax:
Practice Address - Street 1:259 MASS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8406
Practice Address - Country:US
Practice Address - Phone:267-374-6747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty