Provider Demographics
NPI:1326161894
Name:SIWIK, STACIE (LICSW)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:SIWIK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:
Other - Last Name:BILOWZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:6 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-2327
Mailing Address - Country:US
Mailing Address - Phone:603-324-0938
Mailing Address - Fax:
Practice Address - Street 1:50 NASHUA RD STE 205
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3434
Practice Address - Country:US
Practice Address - Phone:603-324-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1143621041C0700X
NH1041C0700X
MA4338101041S0200X
NH20911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool