Provider Demographics
NPI:1255093555
Name:PARADIS, STACY M (OWNER)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:PARADIS
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 CLINTON AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-7014
Mailing Address - Country:US
Mailing Address - Phone:207-649-6506
Mailing Address - Fax:
Practice Address - Street 1:77 CLINTON AVE APT 302
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:ME
Practice Address - Zip Code:04901-7014
Practice Address - Country:US
Practice Address - Phone:207-649-6506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health