Provider Demographics
NPI:1790803344
Name:STEPHENS, STACEY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 W REDWOOD ST
Mailing Address - Street 2:SUITE 570
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1734
Mailing Address - Country:US
Mailing Address - Phone:410-328-6106
Mailing Address - Fax:410-328-1130
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 570
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:410-328-6106
Practice Address - Fax:410-328-1130
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09812101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPVPB-125560OtherAPS