Provider Demographics
NPI:1497306351
Name:MASSHARDT, STACY LEE (LMFT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LEE
Last Name:MASSHARDT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4007
Mailing Address - Country:US
Mailing Address - Phone:774-272-3579
Mailing Address - Fax:
Practice Address - Street 1:709 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4007
Practice Address - Country:US
Practice Address - Phone:717-610-0915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist