Provider Demographics
NPI:1548574965
Name:FORCINO, STACY S (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:S
Last Name:FORCINO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:B
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:18484 US HIGHWAY 18
Mailing Address - Street 2:STE 210
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2375
Mailing Address - Country:US
Mailing Address - Phone:760-995-5134
Mailing Address - Fax:888-843-0969
Practice Address - Street 1:18484 US HIGHWAY 18
Practice Address - Street 2:STE 210
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2375
Practice Address - Country:US
Practice Address - Phone:760-995-5134
Practice Address - Fax:888-843-0969
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25509103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical