Provider Demographics
NPI:1972399087
Name:ARNOLD, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:KAY
Other - Last Name:KALIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4042 PITTMAN PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-3756
Mailing Address - Country:US
Mailing Address - Phone:812-360-4391
Mailing Address - Fax:
Practice Address - Street 1:4042 PITTMAN PL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-3756
Practice Address - Country:US
Practice Address - Phone:812-360-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006225A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical