Provider Demographics
NPI:1558551986
Name:LIEVENSE, STACEY PECKHAM (MD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:PECKHAM
Last Name:LIEVENSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:333 SCHOOL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5334
Mailing Address - Country:US
Mailing Address - Phone:401-724-0600
Mailing Address - Fax:401-724-8306
Practice Address - Street 1:333 SCHOOL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5334
Practice Address - Country:US
Practice Address - Phone:401-724-0600
Practice Address - Fax:401-724-8306
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12440207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology