Provider Demographics
NPI:1285858654
Name:KULIK, STACEY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ELIZABETH
Last Name:KULIK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1630
Mailing Address - Country:US
Mailing Address - Phone:585-613-1736
Mailing Address - Fax:
Practice Address - Street 1:111 MARSH RD
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1630
Practice Address - Country:US
Practice Address - Phone:585-613-1736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0780061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical