Provider Demographics
NPI:1013240449
Name:STAMEN, STACY R (MA, NCC, LMHC)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:R
Last Name:STAMEN
Suffix:
Gender:F
Credentials:MA, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S BUMBY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-6225
Mailing Address - Country:US
Mailing Address - Phone:407-310-4494
Mailing Address - Fax:407-704-7999
Practice Address - Street 1:120 S BUMBY AVE STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-6225
Practice Address - Country:US
Practice Address - Phone:407-310-4494
Practice Address - Fax:407-704-7999
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH # 10030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health