Provider Demographics
NPI:1700096831
Name:BRAIUCA, STACY LYNETTE (MSW,MPH,LCSW,LSCSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNETTE
Last Name:BRAIUCA
Suffix:
Gender:F
Credentials:MSW,MPH,LCSW,LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9507 E 69TH ST
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-5940
Mailing Address - Country:US
Mailing Address - Phone:816-282-2626
Mailing Address - Fax:
Practice Address - Street 1:9507 E 69TH ST
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-5940
Practice Address - Country:US
Practice Address - Phone:816-282-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19991379931041C0700X
KS21621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical