Provider Demographics
NPI:1275785230
Name:LENNY, STACY JEANNE (LICSW, CDP, ACHT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:JEANNE
Last Name:LENNY
Suffix:
Gender:F
Credentials:LICSW, CDP, ACHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 NE 43RD ST STE 213
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5832
Mailing Address - Country:US
Mailing Address - Phone:206-947-1123
Mailing Address - Fax:
Practice Address - Street 1:1314 NE 43RD ST STE 213
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-947-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60334982101YA0400X
WALW609186061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)