Provider Demographics
NPI:1881817138
Name:KAPLAN, STACY H (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:H
Last Name:KAPLAN
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 1:825 BEACON ST STE 19
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1834
Mailing Address - Country:US
Mailing Address - Phone:857-919-1679
Mailing Address - Fax:617-969-4468
Practice Address - Street 1:825 BEACON ST STE 19
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1834
Practice Address - Country:US
Practice Address - Phone:857-919-1679
Practice Address - Fax:617-969-4468
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11111111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303414Medicaid