Provider Demographics
NPI:1508056748
Name:COX, STACIE RENEE (LISW, LCSW, LADAC)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:RENEE
Last Name:COX
Suffix:
Gender:F
Credentials:LISW, LCSW, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CALLE DAVID
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506
Mailing Address - Country:US
Mailing Address - Phone:310-339-6383
Mailing Address - Fax:
Practice Address - Street 1:125 E PALACE AVENUE
Practice Address - Street 2:SUITE 57
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501
Practice Address - Country:US
Practice Address - Phone:310-339-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS239621041C0700X
NMX-076411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical