Provider Demographics
NPI:1770012999
Name:STACEY, JOSE
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:STACEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 S ORANGE AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-6747
Mailing Address - Country:US
Mailing Address - Phone:407-240-7003
Mailing Address - Fax:407-240-7003
Practice Address - Street 1:8000 S ORANGE AVE STE 111
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-6747
Practice Address - Country:US
Practice Address - Phone:407-240-7003
Practice Address - Fax:407-240-7003
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral