Provider Demographics
NPI:1275082760
Name:HALL-MCLEOD, STACEY ANN
Entity Type:Individual
Prefix:
First Name:STACEY ANN
Middle Name:
Last Name:HALL-MCLEOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 83RD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5229
Mailing Address - Country:US
Mailing Address - Phone:718-639-0700
Mailing Address - Fax:
Practice Address - Street 1:17620 148TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5518
Practice Address - Country:US
Practice Address - Phone:718-553-1100
Practice Address - Fax:718-553-1111
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYINTERN101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health