Provider Demographics
NPI:1841582574
Name:STACEY, BERNICE E (MA)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:E
Last Name:STACEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-2665
Mailing Address - Country:US
Mailing Address - Phone:765-593-0003
Mailing Address - Fax:765-593-0032
Practice Address - Street 1:1327 S 18TH ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2665
Practice Address - Country:US
Practice Address - Phone:765-593-0003
Practice Address - Fax:765-593-0032
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health