Provider Demographics
NPI:1699398982
Name:FIORE, STACEY (PSYD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:FIORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 WASHINGTON ST # 244
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6209
Mailing Address - Country:US
Mailing Address - Phone:617-512-7070
Mailing Address - Fax:
Practice Address - Street 1:61 HARRINGTON RIDGE RD
Practice Address - Street 2:
Practice Address - City:SHERBORN
Practice Address - State:MA
Practice Address - Zip Code:01770-1121
Practice Address - Country:US
Practice Address - Phone:617-678-3159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8282103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist