Provider Demographics
NPI:1265905756
Name:HEATH, STACEY LYNELL (LMSW, MPA)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNELL
Last Name:HEATH
Suffix:
Gender:
Credentials:LMSW, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S BRADFORD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4153
Mailing Address - Country:US
Mailing Address - Phone:646-637-6080
Mailing Address - Fax:
Practice Address - Street 1:1001 S BRADFORD ST STE 3
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4153
Practice Address - Country:US
Practice Address - Phone:646-637-6080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
Q3----182104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker