Provider Demographics
NPI:1760978209
Name:HAKANSON-STACY, JANET EILEEN (MSSA)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:EILEEN
Last Name:HAKANSON-STACY
Suffix:
Gender:F
Credentials:MSSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2803
Mailing Address - Country:US
Mailing Address - Phone:413-218-7098
Mailing Address - Fax:
Practice Address - Street 1:1515 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-2536
Practice Address - Country:US
Practice Address - Phone:413-231-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1059731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical