Provider Demographics
NPI:1265595425
Name:ROBERTS, STACEY BAKER (PSYD, LMHC)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:BAKER
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PSYD, LMHC
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD, LMHC
Mailing Address - Street 1:51 UNION ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1194
Mailing Address - Country:US
Mailing Address - Phone:508-769-7812
Mailing Address - Fax:508-519-5882
Practice Address - Street 1:51 UNION ST
Practice Address - Street 2:SUITE 214
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1194
Practice Address - Country:US
Practice Address - Phone:508-769-7812
Practice Address - Fax:508-519-5882
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9916103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist