Provider Demographics
NPI:1235540717
Name:DEAN, STACY (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 FAULCONER DR
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4978
Mailing Address - Country:US
Mailing Address - Phone:434-996-8161
Mailing Address - Fax:
Practice Address - Street 1:503 FAULCONER DR
Practice Address - Street 2:SUITE 7A
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4978
Practice Address - Country:US
Practice Address - Phone:434-996-8161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-18
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist