Provider Demographics
NPI:1073618492
Name:STACY, MARIA GALLIGAN (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:GALLIGAN
Last Name:STACY
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:GALLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2 KIMBALL ST
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938
Mailing Address - Country:US
Mailing Address - Phone:978-356-2924
Mailing Address - Fax:
Practice Address - Street 1:81 HIGHLAND AVE
Practice Address - Street 2:AXELROD 7 WEST
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-354-4600
Practice Address - Fax:978-740-4849
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1113581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical