Provider Demographics
NPI:1245662667
Name:SIMCOCK, STACIE LEE (MSW)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:LEE
Last Name:SIMCOCK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3363
Mailing Address - Country:US
Mailing Address - Phone:401-773-7116
Mailing Address - Fax:
Practice Address - Street 1:1023 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3363
Practice Address - Country:US
Practice Address - Phone:401-773-7116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2022-05-19
Deactivation Date:2022-03-08
Deactivation Code:
Reactivation Date:2022-05-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator