Provider Demographics
NPI:1982717203
Name:JONES, STACY DANIELLE (ATR-BC LCAT)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:DANIELLE
Last Name:JONES
Suffix:
Gender:F
Credentials:ATR-BC LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23-25 FREDERICK STREET FLOOR 1
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-2403
Mailing Address - Country:US
Mailing Address - Phone:518-521-3285
Mailing Address - Fax:
Practice Address - Street 1:209 PARK STREET
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953
Practice Address - Country:US
Practice Address - Phone:518-483-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health