Provider Demographics
NPI:1790349132
Name:NEWMAN, STACEY VIRGINIA (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:VIRGINIA
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 HENRY HUTCHINS RD
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-5772
Mailing Address - Country:US
Mailing Address - Phone:443-532-1444
Mailing Address - Fax:
Practice Address - Street 1:2010 HENRY HUTCHINS RD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-5772
Practice Address - Country:US
Practice Address - Phone:443-532-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD812832866Medicaid