Provider Demographics
NPI:1104237874
Name:CZECH, STEPHANIE JO (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JO
Last Name:CZECH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-2605
Mailing Address - Country:US
Mailing Address - Phone:917-494-3460
Mailing Address - Fax:
Practice Address - Street 1:830 CHALKSTONE AVENUE
Practice Address - Street 2:PROVIDENCE VA MEDICAL CENTER
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4799
Practice Address - Country:US
Practice Address - Phone:401-273-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist