Provider Demographics
NPI:1174677884
Name:KING, STACY J (DEVELOPMENTAL ED)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:J
Last Name:KING
Suffix:
Gender:F
Credentials:DEVELOPMENTAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1786
Mailing Address - Country:US
Mailing Address - Phone:617-569-6560
Mailing Address - Fax:
Practice Address - Street 1:530 BORDER ST.
Practice Address - Street 2:
Practice Address - City:E. BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128
Practice Address - Country:US
Practice Address - Phone:617-569-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator