MEDICARE: STACEY ROSAS LCSW PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1962035972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STACEY ROSAS LCSW PLLC

Provider Business Mailing Address
First Line	:	5224 MOON SHADOW DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78735-6015
Country	:	US
Telephone Number	:	512-587-1107
Fax Number	:

Provider Business Practice Location Address
First Line	:	5224 MOON SHADOW DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78735-6015
Country	:	US
Telephone Number	:	512-587-1107
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. STACEY HILTS ROSAS
Credential	:	LCSW
Telephone Number	:	512-587-1107

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	05/10/2023

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