Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 7720 | MA |
Y | 103TC0700X | Clinical Psychologist | 7720 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 7720 | MA |
N | 103TH0100X | Health Service | 7720 | MA |
N | 103TR0400X | Rehabilitation Psychologist | 7720 | MA |
NPI | 1275656233 |
---|---|
Provider Name | Dr. Stephanie T Machell |
First Address | Saugus, MA 01906-2535 |
Second Address | Belmont, MA 02478-3924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 14/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0500224 | (05) | MA |
406945 | TUFTS HEALTH PLAN (01) | MA |
W05932 | BLUE CROSS OF MA (01) | MA |