Provider Demographics
NPI:1356076889
Name:HENSEL, STACEY LYNN (MA ,MT-BC, LCT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:HENSEL
Suffix:
Gender:F
Credentials:MA ,MT-BC, LCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:1117 8TH AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4338
Mailing Address - Country:US
Mailing Address - Phone:845-220-8653
Mailing Address - Fax:
Practice Address - Street 1:1117 8TH AVE APT 2L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4338
Practice Address - Country:US
Practice Address - Phone:845-220-8653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000742225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist