Provider Demographics
NPI:1871302653
Name:STEPHENS, MITZI DARLENE (LMSW)
Entity type:Individual
Prefix:
First Name:MITZI
Middle Name:DARLENE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WASHINGTON ST APT 9
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-5473
Mailing Address - Country:US
Mailing Address - Phone:945-289-2339
Mailing Address - Fax:
Practice Address - Street 1:25 WASHINGTON ST APT 9
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5473
Practice Address - Country:US
Practice Address - Phone:945-289-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical