Provider Demographics
NPI:1992543839
Name:STERN, CARLY DANIELLE (PSYD)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:DANIELLE
Last Name:STERN
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 1:25870 FRANKLIN PARK CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2222
Mailing Address - Country:US
Mailing Address - Phone:248-505-5126
Mailing Address - Fax:
Practice Address - Street 1:53 PARKER HILL AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-3225
Practice Address - Country:US
Practice Address - Phone:617-232-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent