Provider Demographics
NPI:1306980081
Name:STEIN, ABBY LISA (MED,LICSW)
Entity type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:LISA
Last Name:STEIN
Suffix:
Gender:F
Credentials:MED,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WATERMAN ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2125
Mailing Address - Country:US
Mailing Address - Phone:401-654-4618
Mailing Address - Fax:401-383-9133
Practice Address - Street 1:150 WATERMAN ST
Practice Address - Street 2:SUITE G
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2125
Practice Address - Country:US
Practice Address - Phone:401-654-4618
Practice Address - Fax:401-383-9133
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW001991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI809007296Medicare ID - Type Unspecified