Provider Demographics
NPI:1013149731
Name:HENSON, STACEY MARSHALL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MARSHALL
Last Name:HENSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 NORTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1534
Mailing Address - Country:US
Mailing Address - Phone:860-586-9465
Mailing Address - Fax:860-232-5049
Practice Address - Street 1:91 NORTHWEST DR
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1534
Practice Address - Country:US
Practice Address - Phone:860-586-9465
Practice Address - Fax:860-232-5049
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW67001041C0700X
CT0080861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical