Provider Demographics
NPI:1689690638
Name:TAYLOR, STACY ROBIN (LCSW MSW)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:ROBIN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 SOLANO AVENUE
Mailing Address - Street 2:#304
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707
Mailing Address - Country:US
Mailing Address - Phone:510-559-3440
Mailing Address - Fax:
Practice Address - Street 1:1760 SOLANO AVENUE
Practice Address - Street 2:#304
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707
Practice Address - Country:US
Practice Address - Phone:510-559-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS134701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical