Provider Demographics
NPI:1851690408
Name:ST LOUIS, STACY (LICSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:ST LOUIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TRUMAN DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3828
Mailing Address - Country:US
Mailing Address - Phone:617-335-0156
Mailing Address - Fax:
Practice Address - Street 1:89 A ST STE 120
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2806
Practice Address - Country:US
Practice Address - Phone:855-860-4949
Practice Address - Fax:781-493-7909
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220601104100000X
MA1236641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker