Provider Demographics
NPI:1083141428
Name:COLAIZZO, STACY DOWNS (MA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:DOWNS
Last Name:COLAIZZO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28081 MARGUERITE PKWY # 2543
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92690-1800
Mailing Address - Country:US
Mailing Address - Phone:949-478-2292
Mailing Address - Fax:
Practice Address - Street 1:21515 HAWTHORNE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6512
Practice Address - Country:US
Practice Address - Phone:949-478-2292
Practice Address - Fax:949-478-2292
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC97281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
578368OtherMHN