Provider Demographics
NPI:1477981629
Name:SMITH, STACIE ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STACIE
Middle Name:ANNE
Last Name:SMITH
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 1:1129 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-6418
Mailing Address - Country:US
Mailing Address - Phone:302-422-8026
Mailing Address - Fax:
Practice Address - Street 1:1129 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-6418
Practice Address - Country:US
Practice Address - Phone:302-422-8026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00012511041C0700X
PACW0173381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical