Provider Demographics
NPI:1891862124
Name:LEVASSEUR, STACY (MED)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:LEVASSEUR
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 MERRILL ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:NH
Mailing Address - Zip Code:03223-6131
Mailing Address - Country:US
Mailing Address - Phone:603-536-1118
Mailing Address - Fax:
Practice Address - Street 1:111 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3432
Practice Address - Country:US
Practice Address - Phone:603-536-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7706646Y0NH01OtherANTHEM
NH889984AOtherMVP HEALTHCARE