Provider Demographics
NPI:1023291382
Name:MENZIESS, STACY N (CASE MANAGER)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:N
Last Name:MENZIESS
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W REDONDO BEACH BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-1612
Mailing Address - Country:US
Mailing Address - Phone:310-352-6422
Mailing Address - Fax:310-352-6480
Practice Address - Street 1:555 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-1612
Practice Address - Country:US
Practice Address - Phone:310-352-6422
Practice Address - Fax:310-352-6480
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health