Provider Demographics
NPI:1083973515
Name:OLIVER, STACY MARIE (MED)
Entity Type:Individual
Prefix:MISS
First Name:STACY
Middle Name:MARIE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FENNO ST APT 14
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-3927
Mailing Address - Country:US
Mailing Address - Phone:781-733-5920
Mailing Address - Fax:
Practice Address - Street 1:75 FENNO ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-3946
Practice Address - Country:US
Practice Address - Phone:781-733-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health