Provider Demographics
NPI:1356449706
Name:STETSON, STACEY R (LCSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:R
Last Name:STETSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:NUNEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:11 MARCONI ST
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1420
Mailing Address - Country:US
Mailing Address - Phone:917-572-8488
Mailing Address - Fax:
Practice Address - Street 1:11 MARCONI ST
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-1420
Practice Address - Country:US
Practice Address - Phone:917-572-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0721881041C0700X
NY07218811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical