Provider Demographics
NPI:1720202674
Name:GAPPA, STACEY MARIE (LCSW, LMSW)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MARIE
Last Name:GAPPA
Suffix:
Gender:F
Credentials:LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70239 BEACH DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112-9436
Mailing Address - Country:US
Mailing Address - Phone:574-302-6094
Mailing Address - Fax:
Practice Address - Street 1:70239 BEACH DR
Practice Address - Street 2:
Practice Address - City:EDWARDSBURG
Practice Address - State:MI
Practice Address - Zip Code:49112-9436
Practice Address - Country:US
Practice Address - Phone:574-302-6094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008919A104100000X
MI6801106723104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker