Provider Demographics
NPI:1457803934
Name:MANTEL, STACY (LPC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:MANTEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRADLEY RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2285
Mailing Address - Country:US
Mailing Address - Phone:203-819-7316
Mailing Address - Fax:
Practice Address - Street 1:1 BRADLEY RD
Practice Address - Street 2:SUITE 206
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2285
Practice Address - Country:US
Practice Address - Phone:203-819-7316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.003038101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health