Provider Demographics
NPI:1114104098
Name:GARTON, STACY LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:GARTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:MAYNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:3516 E JEFFERSON BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-3034
Mailing Address - Country:US
Mailing Address - Phone:574-287-4197
Mailing Address - Fax:574-287-4393
Practice Address - Street 1:919 E JEFFERSON BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-3112
Practice Address - Country:US
Practice Address - Phone:574-287-4197
Practice Address - Fax:574-287-4393
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2550481041C0700X
IN34005864A1041C0700X
ORL130601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical