Provider Demographics
NPI:1154928893
Name:STEPHENS-MALLOY, CHRISTINA (LICSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:STEPHENS-MALLOY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 SIMPSON RD
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:ME
Mailing Address - Zip Code:04093-6213
Mailing Address - Country:US
Mailing Address - Phone:617-522-5732
Mailing Address - Fax:
Practice Address - Street 1:474 SIMPSON RD
Practice Address - Street 2:
Practice Address - City:BUXTON
Practice Address - State:ME
Practice Address - Zip Code:04093-6213
Practice Address - Country:US
Practice Address - Phone:617-229-5732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC249681041C0700X
MA1240411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical