Provider Demographics
NPI:1356321012
Name:FRANCONE, STACEY M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:M
Last Name:FRANCONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:M
Other - Last Name:FRANCONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:262 E 3900 S STE 125
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-1500
Mailing Address - Country:US
Mailing Address - Phone:801-209-8690
Mailing Address - Fax:385-528-1635
Practice Address - Street 1:262 E 3900 S STE 125
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1500
Practice Address - Country:US
Practice Address - Phone:801-209-8690
Practice Address - Fax:385-528-1635
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT136162-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942938348015OtherCHAMPUS
UT107029371101OtherINTERMOUNTAIN HEALTH CARE
UT942938348FR3OtherEDUCATORS MUTUAL
UT314565OtherDESERET MUTUAL
UT107029371101OtherINTERMOUNTAIN HEALTH CARE