STEPHANIE L BLENNER (NPI# 1518946466) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518946466 |
| Entity Type | Individual |
| Full Name | STEPHANIE L BLENNER |
| Credential | M.D. |
| Practice Address |
55 Lake Ave N Worcester MA 01655-0002 |
| Mailing Address |
Po Box 415348 Boston MA 02241-5348 |
| Practice Telephone | 7744423028 |
| Practice Fax Number | 7744426740 |
| Mailing Telephone | 8002258885 |
| Mailing Fax Number | 5083341977 |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2017-04-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 216795 | MA | Allopathic & Osteopathic Physicians |
| Y | 2080P0006X |
Pediatrics Specialization: Developmental – Behavioral Pediatrics |
216795 | MA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 110034009A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487121240 | Stephanie Gloria Blenner | Physician Assistant | 1010 Sunrise Hwy, Rockville Centre, NY 11570-5100 | 2018-10-30 |
| Street Address |
55 LAKE AVE N |
| City | WORCESTER |
| State | MA |
| Zip Code | 01655-0002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477556587 | James E Liebmann | Internal Medicine | 55 Lake Ave N, Hematology/oncology, Worcester, MA 01655-0002 | 2005-05-23 |
| 1518568732 | Justin Bullard | Psychologist | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-11-04 |
| 1346849825 | Meghan Moore | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-10-26 |
| 1174122899 | Jessica Goncalves Ferreira | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-10-23 |
| 1235746686 | Desiree Mytych | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-09-29 |
| 1659986248 | Rebecca Lynn Harris | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-09-10 |
| 1639781487 | Gabriella Kathleen Holland | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-21 |
| 1730791898 | Kerry Anne Benedict | Speech-Language Pathologist | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-20 |
| 1902418999 | Natasha R. Turner | Genetic Counselor, MS | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-20 |
| 1144830712 | Abbey Corsini | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205489713 | Darryl Sweeper Jr. | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Psychiatry, Umass Memorial Medical Center, Worcester, MA 01655 | 2019-07-23 |
| 1225690530 | Ryan Zenevitch | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Family Medicine, Umass Memorial Medical Center, Worcester, MA 01655 | 2019-07-08 |
| 1932688454 | Victoria Sayeg | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Pediatrics, Worcester, MA 01655 | 2018-08-07 |
| 1114425675 | Judith Dio Wentzell | Social Worker | Umassmemorial Medical Center, 55 Lake Ave North, Dept of Care Coordination, Worcester, MA 01655 | 2018-01-30 |
| 1861927386 | Muhammad Waqas Khan | Student in an Organized Health Care Education/Training Program | University of Massachusetts 55 North Lake Ave, Neurology, Worcester, MA 01655 | 2017-04-21 |
| 1861806192 | Qaiser Shamshir Khan | Psychiatry & Neurology | 55 Lake Ave N # S7-831, Worcester, MA 01655 | 2014-06-14 |
| 1073858981 | Heidi Glover | Nurse Practitioner | 55 Lake Ave North Dept. of Pedi-adolescent, Ummc University Campus, Worcester, MA 01655 | 2012-12-04 |
| 1972867992 | Anna Bjornsdottir | Psychiatry & Neurology | 55 Lake Av N, Worcester, MA 01655 | 2012-06-25 |
| 1245567676 | Steven Edward Mckinley | Nurse Practitioner | 55 Lake Ave. North, Umass Memorial Medical Center University Campus, Worcester, MA 01655 | 2009-11-05 |
| 1851582951 | Robin I Davidson | Neurological Surgery | 55 Lake Ave, North, Ummhc-univ Campus, Worcester, MA 01655 | 2007-08-05 |
| Find all providers in zip 01655 | ||||
| Taxonomy Code | 2080P0006X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Developmental – Behavioral Pediatrics |
| A developmental-behavioral specialist is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children and in the family dysfunctions that compromise children's development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed, 3/26/2008: definition corrected] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821638701 | Anna Soles | Pediatrics | 345a Greenwood St Ste B, Worcester, MA 01607-1753 | 2020-01-08 |
| 1225249196 | Deborah Lynne Shipman | Pediatrics | 5 Neponset St, Worcester, MA 01606-2714 | 2007-05-24 |
| 1922192822 | Kathleen Braden | Pediatrics | 55 Lake Ave N, Department of Pediatrics, Worcester, MA 01655-0002 | 2006-10-03 |
| 1720078124 | Robin H Adair | Pediatrics | 55 Lake Ave N, Department of Developmental Behavioral Pediatrics, Worcester, MA 01655-0002 | 2005-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518455021 | Taylor K. Baker | Pediatrics | 12 Ridge Rd, Foxborough, MA 02035-1400 | 2018-04-30 |
| 1285018911 | Amel Alawami | Pediatrics | 800 Washington St # 334, Boston, MA 02111-1552 | 2015-07-13 |
| 1235541152 | Naomi Bloom Gershon | Pediatrics | 100 High St Ste 200, Westwood, MA 02090-1100 | 2014-05-27 |
| 1831225424 | Ramzi H Nasir | Pediatrics | Children's Hospital, Gen'l Pediatrics, 300 Longwood Ave., Boston, MA 02115 | 2007-02-26 |
| 1972667103 | Winifred B Parker | Pediatrics | 20 Lincoln Rd, Wayland, MA 01778-1302 | 2006-12-21 |
| 1083787634 | William Austin Haffner Sammons | Pediatrics | 84 Moorland St, Williamstown, MA 01267-2410 | 2006-11-15 |
| 1831284041 | Daniel Nussbaum II | Pediatrics | 5 Dover St, Suite 103, New Bedford, MA 02740-6258 | 2006-10-04 |
| 1962416461 | Dennis J Rosen | Pediatrics | 157 Columbia Drive, Amherst, MA 01002 | 2006-07-28 |
| 1417996273 | Laurel Kristin Leslie | Pediatrics | 800 Washington St # Mc345, Tufts Medical Center Floating Hospital for Children, Boston, MA 02111-1552 | 2006-06-06 |
| 1659328433 | Marcel Kinsbourne | Pediatrics | 158 Cambridge St, Winchester, MA 01890-2414 | 2006-05-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.