Provider Demographics
NPI:1568078061
Name:STACEY DATNOW, LCSW, INC.
Entity Type:Organization
Organization Name:STACEY DATNOW, LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:FRAN
Authorized Official - Last Name:DATNOW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-990-0307
Mailing Address - Street 1:28348 ROADSIDE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2596
Mailing Address - Country:US
Mailing Address - Phone:310-990-0307
Mailing Address - Fax:818-699-6053
Practice Address - Street 1:28348 ROADSIDE DR STE 201
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2596
Practice Address - Country:US
Practice Address - Phone:818-276-3242
Practice Address - Fax:818-699-6053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-20
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1295836963OtherNPPES