Provider Demographics
NPI:1518088327
Name:GAY, STACEY LYNNE (MS COUNSELING PSYC)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LYNNE
Last Name:GAY
Suffix:
Gender:F
Credentials:MS COUNSELING PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MCINTOSH DR
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-7168
Mailing Address - Country:US
Mailing Address - Phone:508-880-8876
Mailing Address - Fax:
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:TAUNTON CLINIC
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2778
Practice Address - Country:US
Practice Address - Phone:508-821-7777
Practice Address - Fax:508-822-2601
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1309161Medicaid