Provider Demographics
NPI:1821437443
Name:DELANOIT, STACEY (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:DELANOIT
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 748519
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8519
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:
Practice Address - Street 1:1747 BAPTIST CLAY DR STE 350
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8504
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE991103T00000X
NE457103TC0700X
FLPY11244103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1851916373OtherNPI 2
NE1821437443OtherNPI 1
NE$$$$$$$$$Medicaid