Provider Demographics
NPI:1265870737
Name:HYDE, STACY (LCSW)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HYDE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1726 SE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2514
Mailing Address - Country:US
Mailing Address - Phone:954-522-4749
Mailing Address - Fax:
Practice Address - Street 1:1726 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2514
Practice Address - Country:US
Practice Address - Phone:954-522-4749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW108401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical