Provider Demographics
NPI:1629234786
Name:ANGUS, STACEY LEE (LCSW,CAS, MAC)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LEE
Last Name:ANGUS
Suffix:
Gender:F
Credentials:LCSW,CAS, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12803-4923
Mailing Address - Country:US
Mailing Address - Phone:518-479-9971
Mailing Address - Fax:
Practice Address - Street 1:129 HUDSON ST
Practice Address - Street 2:
Practice Address - City:SOUTH GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12803-4923
Practice Address - Country:US
Practice Address - Phone:518-479-9971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEC-4560101YA0400X
MELC114361041C0700X
NY0813071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)