Provider Demographics
NPI:1710012786
Name:GOLD, STACIE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:
Other - Last Name:FRANKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1517 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2461
Mailing Address - Country:US
Mailing Address - Phone:410-626-7800
Mailing Address - Fax:
Practice Address - Street 1:1517 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2461
Practice Address - Country:US
Practice Address - Phone:410-626-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD212150600Medicaid