Provider Demographics
NPI:1619036753
Name:PERDUE, STACIE VERNICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:VERNICK
Last Name:PERDUE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:STACIE
Other - Middle Name:H
Other - Last Name:VERNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:51 SOUTH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-8106
Mailing Address - Country:US
Mailing Address - Phone:973-539-5600
Mailing Address - Fax:973-539-5625
Practice Address - Street 1:51 SOUTH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-8106
Practice Address - Country:US
Practice Address - Phone:973-539-5600
Practice Address - Fax:973-539-5625
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4381103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist