Provider Demographics
NPI:1396520391
Name:GREAVES, STACEY A (LMSW)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:A
Last Name:GREAVES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 PINE HEIGHTS AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5202
Mailing Address - Country:US
Mailing Address - Phone:443-219-7901
Mailing Address - Fax:
Practice Address - Street 1:1001 PINE HEIGHTS AVE STE 303
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5202
Practice Address - Country:US
Practice Address - Phone:443-219-7901
Practice Address - Fax:443-835-2521
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30490104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker