Provider Demographics
NPI:1245761428
Name:FOSTER, STACEY (LISW-S)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 PINE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4849
Mailing Address - Country:US
Mailing Address - Phone:614-202-3463
Mailing Address - Fax:
Practice Address - Street 1:5025 PINE CREEK DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4849
Practice Address - Country:US
Practice Address - Phone:614-202-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14402731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical