Provider Demographics
NPI:1639306285
Name:STACY, TESSA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TESSA
Middle Name:ELIZABETH
Last Name:STACY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TESSA
Other - Middle Name:ELIZABETH
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 COURT ST.
Mailing Address - Street 2:SUITE 42
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815
Mailing Address - Country:US
Mailing Address - Phone:607-337-1600
Mailing Address - Fax:607-334-4519
Practice Address - Street 1:5 COURT ST.
Practice Address - Street 2:SUITE 42
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815
Practice Address - Country:US
Practice Address - Phone:607-337-1600
Practice Address - Fax:607-334-4519
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079115104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker