Provider Demographics
NPI:1336230044
Name:KRIESBERG, STEPHANIE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:M
Last Name:KRIESBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WINTERBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1573
Mailing Address - Country:US
Mailing Address - Phone:781-275-7538
Mailing Address - Fax:781-275-7538
Practice Address - Street 1:3 ESSEX GREEN DR
Practice Address - Street 2:SUITE 1
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2927
Practice Address - Country:US
Practice Address - Phone:978-532-3993
Practice Address - Fax:978-532-6366
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMEW50041Medicare ID - Type Unspecified