Provider Demographics
NPI:1619315702
Name:OTT, STACY J (BS)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:J
Last Name:OTT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MARGIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3341
Mailing Address - Country:US
Mailing Address - Phone:978-744-0500
Mailing Address - Fax:978-740-3832
Practice Address - Street 1:56 MARGIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3341
Practice Address - Country:US
Practice Address - Phone:978-744-0500
Practice Address - Fax:978-740-3832
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor