Provider Demographics
NPI:1700453677
Name:TARRICONE, STACEY (BS)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:TARRICONE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-1647
Mailing Address - Country:US
Mailing Address - Phone:401-744-3409
Mailing Address - Fax:
Practice Address - Street 1:62 BROWN ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6778
Practice Address - Country:US
Practice Address - Phone:978-744-1585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health