Provider Demographics
NPI:1235507302
Name:STAPLETON, FALLON (LCSW)
Entity Type:Individual
Prefix:
First Name:FALLON
Middle Name:
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:FALLON
Other - Middle Name:MARIE
Other - Last Name:ROSSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:719 NARAMORE ST
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-6921
Mailing Address - Country:US
Mailing Address - Phone:845-988-7596
Mailing Address - Fax:
Practice Address - Street 1:209 DELBURG ST STE 101
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-6914
Practice Address - Country:US
Practice Address - Phone:845-988-7596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP011368104100000X
390200000X
NCC0153881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program