Provider Demographics
NPI:1275989519
Name:HALE, STACY MICHELLE (MA, MED, LPC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MICHELLE
Last Name:HALE
Suffix:
Gender:F
Credentials:MA, MED, LPC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:MICHELLE
Other - Last Name:PELHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:402 MAIN ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1846
Mailing Address - Country:US
Mailing Address - Phone:732-635-9797
Mailing Address - Fax:732-635-1711
Practice Address - Street 1:402 MAIN ST
Practice Address - Street 2:SUITE #201
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-1846
Practice Address - Country:US
Practice Address - Phone:732-635-9797
Practice Address - Fax:732-635-1711
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00549700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional