Provider Demographics
NPI:1487787313
Name:PRIOR, STEPHEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:PRIOR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-2230
Mailing Address - Country:US
Mailing Address - Phone:781-235-6738
Mailing Address - Fax:
Practice Address - Street 1:358 WASHINGTON ST
Practice Address - Street 2:REAR
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6206
Practice Address - Country:US
Practice Address - Phone:781-235-6738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3784103TC0700X, 103TP0814X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPR W03758OtherBCBSPIN
MA713217OtherTUFTS HEALTH PLAN