Provider Demographics
NPI:1104339787
Name:CHANCEY, STEPHANIE (MA, R-DMT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CHANCEY
Suffix:
Gender:F
Credentials:MA, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 WATERTOWN STREET
Mailing Address - Street 2:THE ACADEMY
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458
Mailing Address - Country:US
Mailing Address - Phone:617-969-2200
Mailing Address - Fax:617-244-4906
Practice Address - Street 1:425 WATERTOWN STREET
Practice Address - Street 2:THE ACADEMY
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458
Practice Address - Country:US
Practice Address - Phone:617-969-2200
Practice Address - Fax:617-244-4906
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health