Provider Demographics
NPI:1598187957
Name:LLOYD, STACEY LEE (CRC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LEE
Last Name:LLOYD
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:DENNISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1034 N CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PORTER CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12859-1906
Mailing Address - Country:US
Mailing Address - Phone:518-796-1027
Mailing Address - Fax:
Practice Address - Street 1:1034 N CREEK RD
Practice Address - Street 2:
Practice Address - City:PORTER CORNERS
Practice Address - State:NY
Practice Address - Zip Code:12859-1906
Practice Address - Country:US
Practice Address - Phone:518-796-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-19
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor