Stacie, Mary Anna
Stacie, Mary Anna is an individual health care provider with primary practice located at 151 Hazard Ave , Enfield CT 06082-4584. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Stacie, Mary Anna can be contacted via phone (860) 763-8044.Contact Information
Primary practice address
151 Hazard Ave
Enfield CT 06082-4584
Phone: (860) 763-8044
Fax: (860) 272-2990
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 001652 | Connecticut |
Profile Details
| NPI number | 1114199387 |
|---|---|
| LBN Legal business name | Stacie, Mary Anna |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 28th, 2008 |
| Last updated | May 28th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114199387 | NPPES |
| Connecticut | MEDICAID | PENDING |
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