Provider Demographics
NPI:1992012876
Name:WISIOROWSKI, STACEY CATHERINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:CATHERINE
Last Name:WISIOROWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:STACEY
Other - Middle Name:CATHERINE
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1251
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-5251
Mailing Address - Country:US
Mailing Address - Phone:808-639-9359
Mailing Address - Fax:808-245-9818
Practice Address - Street 1:2970 KELE ST
Practice Address - Street 2:SUITE 109
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1823
Practice Address - Country:US
Practice Address - Phone:808-639-9359
Practice Address - Fax:808-245-9818
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-31031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical