Provider Demographics
NPI:1245249606
Name:TELLI, STACY ROBIN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ROBIN
Last Name:TELLI
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 PEMBERTON HILL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4269
Mailing Address - Country:US
Mailing Address - Phone:919-303-0273
Mailing Address - Fax:919-303-5986
Practice Address - Street 1:1091 PEMBERTON HILL RD STE 102
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4269
Practice Address - Country:US
Practice Address - Phone:919-303-0273
Practice Address - Fax:919-303-5986
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0042641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC004264OtherLCSW LICENSE NUMBER
NC134KMOtherBCBS