Provider Demographics
NPI:1346734019
Name:GROVE, STACY (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:GROVE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:SHIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:4571 RICKER ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-2802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2215 FOREST HILLS DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1099
Practice Address - Country:US
Practice Address - Phone:717-963-8507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker