Provider Demographics
NPI:1447413596
Name:MUOLO, STACEE J (LMSW, CASAC)
Entity Type:Individual
Prefix:
First Name:STACEE
Middle Name:J
Last Name:MUOLO
Suffix:
Gender:F
Credentials:LMSW, CASAC
Other - Prefix:
Other - First Name:STACEE
Other - Middle Name:J
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 MUNSON ST
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-8933
Mailing Address - Country:US
Mailing Address - Phone:585-658-5023
Mailing Address - Fax:
Practice Address - Street 1:80 MUNSON ST
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-8933
Practice Address - Country:US
Practice Address - Phone:585-658-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor