Provider Demographics
NPI:1588680284
Name:MAGGARD, STACEY A (LISW-CASAC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:A
Last Name:MAGGARD
Suffix:
Gender:F
Credentials:LISW-CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7545 CALYX DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5285
Mailing Address - Country:US
Mailing Address - Phone:505-362-3421
Mailing Address - Fax:505-897-7561
Practice Address - Street 1:7545 CALYX DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5285
Practice Address - Country:US
Practice Address - Phone:505-362-3421
Practice Address - Fax:505-897-7561
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM38261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical