Provider Demographics
NPI:1972030054
Name:FIORILLO, STACEY ELIZABETH (MS, LCGC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ELIZABETH
Last Name:FIORILLO
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ELIZABETH
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 TWIN LAKES RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06068-1402
Mailing Address - Country:US
Mailing Address - Phone:239-896-4429
Mailing Address - Fax:
Practice Address - Street 1:75 CLAREMONT RD
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2262
Practice Address - Country:US
Practice Address - Phone:908-766-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MJ00023700170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS