Provider Demographics
NPI:1265688345
Name:ROBINSON, STACEY LARISE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LARISE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 W FOREST PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-1426
Mailing Address - Country:US
Mailing Address - Phone:443-742-4329
Mailing Address - Fax:410-367-1511
Practice Address - Street 1:3407 W FOREST PARK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-1426
Practice Address - Country:US
Practice Address - Phone:410-367-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14195104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker