Provider Demographics
NPI:1629318134
Name:BARRETT, STACY MICHELE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MICHELE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7516 CORAL RIVER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2642
Mailing Address - Country:US
Mailing Address - Phone:702-400-2552
Mailing Address - Fax:
Practice Address - Street 1:7516 CORAL RIVER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2642
Practice Address - Country:US
Practice Address - Phone:702-400-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4585-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker