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:
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Health care specialties

SpecialtyCodeLicense #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 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114199387 NPPES
Connecticut MEDICAID PENDING

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