Provider Demographics
NPI:1598911075
Name:WINTER, STACY CANARISA (LCSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:CANARISA
Last Name:WINTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:CANARISA
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:434 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-1206
Mailing Address - Country:US
Mailing Address - Phone:570-884-4662
Mailing Address - Fax:
Practice Address - Street 1:434 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MIFFLINBURG
Practice Address - State:PA
Practice Address - Zip Code:17844-1206
Practice Address - Country:US
Practice Address - Phone:570-884-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125711104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker