Provider Demographics
NPI:1568568830
Name:ADLER, STACY BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:BETH
Last Name:ADLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 S VAL VISTA DR # 214
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6401
Mailing Address - Country:US
Mailing Address - Phone:480-776-3368
Mailing Address - Fax:
Practice Address - Street 1:1237 S VAL VISTA DR
Practice Address - Street 2:STE 114
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6401
Practice Address - Country:US
Practice Address - Phone:480-776-3368
Practice Address - Fax:480-396-0532
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW36281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical