Provider Demographics
NPI:1699210591
Name:RAMIREZ, STACEY (MS TCMS, PPS, PCCI)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:MS TCMS, PPS, PCCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7966 PEDLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-5055
Mailing Address - Country:US
Mailing Address - Phone:909-659-6055
Mailing Address - Fax:
Practice Address - Street 1:244 S D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-2004
Practice Address - Country:US
Practice Address - Phone:909-890-9318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCCI3414101YM0800X
CA160133412101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool