Provider Demographics
NPI:1851411599
Name:KUMAR, STACY (MS)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 579776
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-9776
Mailing Address - Country:US
Mailing Address - Phone:209-677-7545
Mailing Address - Fax:
Practice Address - Street 1:1700 MCHENRY VILLAGE WAY # 11
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4308
Practice Address - Country:US
Practice Address - Phone:209-526-1476
Practice Address - Fax:209-526-0908
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47545106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist