Provider Demographics
NPI:1104377274
Name:ALLEN, STACEY H (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:H
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MARCELLA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4164
Mailing Address - Country:US
Mailing Address - Phone:973-736-2041
Mailing Address - Fax:
Practice Address - Street 1:8 MARCELLA AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4164
Practice Address - Country:US
Practice Address - Phone:973-736-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05951700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker