Provider Demographics
NPI:1609353929
Name:STAY, PATRICE R
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:R
Last Name:STAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 FLORENCE ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2642
Mailing Address - Country:US
Mailing Address - Phone:603-296-5269
Mailing Address - Fax:
Practice Address - Street 1:187 FLORENCE ST APT 2R
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2642
Practice Address - Country:US
Practice Address - Phone:603-296-5269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1192911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical