Provider Demographics
NPI:1033430269
Name:PIMENTEL, STACEY E (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:E
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:E
Other - Last Name:BIANCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:PO BOX 3255
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-0900
Mailing Address - Country:US
Mailing Address - Phone:978-430-6373
Mailing Address - Fax:844-750-6903
Practice Address - Street 1:128 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081
Practice Address - Country:US
Practice Address - Phone:978-430-6373
Practice Address - Fax:844-750-6903
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8207101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health