Provider Demographics
NPI:1609043686
Name:TESSEYMAN, STACEY (LCSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:TESSEYMAN
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 1:177 PRINCE ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2946
Mailing Address - Country:US
Mailing Address - Phone:212-330-1446
Mailing Address - Fax:212-330-1446
Practice Address - Street 1:177 PRINCE ST
Practice Address - Street 2:SUITE 408
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2946
Practice Address - Country:US
Practice Address - Phone:212-330-1446
Practice Address - Fax:212-330-1446
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071113-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical