Provider Demographics
NPI:1912152588
Name:GALVEZ, STACEY E (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:E
Last Name:GALVEZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:STACEY
Other - Middle Name:E
Other - Last Name:PIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 BERNARD ST
Mailing Address - Street 2:LAWRENCE
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559
Mailing Address - Country:US
Mailing Address - Phone:516-458-3427
Mailing Address - Fax:516-371-0675
Practice Address - Street 1:18 BERNARD ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1245
Practice Address - Country:US
Practice Address - Phone:516-239-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT283920174N00000X
NY019684-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN