Provider Demographics
NPI:1881806990
Name:KLEIN, STACY CARA (LCSW)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:CARA
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LONG ACRE LANE
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7926
Mailing Address - Country:US
Mailing Address - Phone:631-499-0139
Mailing Address - Fax:631-486-1938
Practice Address - Street 1:10 LONG ACRE LANE
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-7926
Practice Address - Country:US
Practice Address - Phone:631-499-0139
Practice Address - Fax:631-486-1938
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0539551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical