Provider Demographics
NPI:1154838431
Name:STACO, STEPHANIE JEANINE-ELIZABETH (LMHC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JEANINE-ELIZABETH
Last Name:STACO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:DANDREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:819 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3517
Mailing Address - Country:US
Mailing Address - Phone:516-578-4567
Mailing Address - Fax:
Practice Address - Street 1:819 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:NORTH WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11581-3517
Practice Address - Country:US
Practice Address - Phone:516-578-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010484101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health