Provider Demographics
NPI:1235413717
Name:LADDEN, STACY LEVIN (PSYD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LEVIN
Last Name:LADDEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OFFICE PARK CIR STE 215A
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2533
Mailing Address - Country:US
Mailing Address - Phone:205-414-6686
Mailing Address - Fax:
Practice Address - Street 1:4 OFFICE PARK CIR STE 215A
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2533
Practice Address - Country:US
Practice Address - Phone:205-414-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1715103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical