Provider Demographics
NPI:1609099506
Name:CARPENTER, STACY A (LICSW, MLADC)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:A
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LICSW, MLADC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:A
Other - Last Name:LACORCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CTRS
Mailing Address - Street 1:55 SHERBORNE ROAD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-5519
Mailing Address - Country:US
Mailing Address - Phone:603-571-4317
Mailing Address - Fax:
Practice Address - Street 1:323 GONIC ROAD SUITE 5
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03839-4592
Practice Address - Country:US
Practice Address - Phone:603-332-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0988101YA0400X
NH39488225800000X
NH22471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist