Provider Demographics
NPI:1396180584
Name:SCHWARTZ, STACEY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 VERA LN
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2113
Mailing Address - Country:US
Mailing Address - Phone:610-825-4450
Mailing Address - Fax:610-941-5532
Practice Address - Street 1:200 BARR HARBOR DR STE
Practice Address - Street 2:
Practice Address - City:W CNSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2978
Practice Address - Country:US
Practice Address - Phone:484-362-9802
Practice Address - Fax:888-343-2014
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0175711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA367703ZBKWMedicare PIN