Provider Demographics
NPI:1093039802
Name:MCCARTHY, STACEY R (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:R
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 PINE OAK TRL
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-7206
Mailing Address - Country:US
Mailing Address - Phone:407-321-2793
Mailing Address - Fax:
Practice Address - Street 1:1600 TOWN PLAZA CT
Practice Address - Street 2:SUITE 1612
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6210
Practice Address - Country:US
Practice Address - Phone:321-765-4982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist