Provider Demographics
NPI:1083879605
Name:HILL, STACEY SUZANNE (BSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:SUZANNE
Last Name:HILL
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 FLORIDA ST APT 14
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-6204
Mailing Address - Country:US
Mailing Address - Phone:626-429-9936
Mailing Address - Fax:
Practice Address - Street 1:3875 FLORIDA ST APT 14
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-6204
Practice Address - Country:US
Practice Address - Phone:626-429-9936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical