Basic Information
| Provider Information | |||||||||
| NPI: | 1457952988 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | JARRED | ||||||||
| MiddleName: | KRISTOPHER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 SUMMER ST | ||||||||
| Address2: | |||||||||
| City: | HAVERHILL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018306032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783737010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 116 SUMMER ST | ||||||||
| Address2: | |||||||||
| City: | HAVERHILL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018306032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783737010 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2020 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.