Provider Demographics
NPI:1073708244
Name:AGUIRRE, STACEY ANN
Entity Type:Individual
Prefix:MISS
First Name:STACEY
Middle Name:ANN
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 FAIRVIEW ST APT B
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2364
Mailing Address - Country:US
Mailing Address - Phone:510-658-7720
Mailing Address - Fax:
Practice Address - Street 1:161 MITCHELL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2068
Practice Address - Country:US
Practice Address - Phone:415-499-6828
Practice Address - Fax:415-499-3080
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor